Healthcare Provider Details

I. General information

NPI: 1932020401
Provider Name (Legal Business Name): SELINA DICKEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 PARKRIDGE WAY
SIMPSONVILLE SC
29680
US

IV. Provider business mailing address

317 PARKRIDGE WAY
SIMPSONVILLE SC
29680
US

V. Phone/Fax

Practice location:
  • Phone: 864-525-4960
  • Fax:
Mailing address:
  • Phone: 864-525-4960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: