Healthcare Provider Details

I. General information

NPI: 1205715414
Provider Name (Legal Business Name): SELAH GREY FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2025
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 CANNON ST
GREER SC
29651-3703
US

IV. Provider business mailing address

119 MISTY MEADOW DR
GREENVILLE SC
29615-6162
US

V. Phone/Fax

Practice location:
  • Phone: 864-704-0970
  • Fax: 864-767-6640
Mailing address:
  • Phone: 864-704-0970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: ROBYN SMITH
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 864-704-0970