Healthcare Provider Details

I. General information

NPI: 1841894052
Provider Name (Legal Business Name): SELENA LAVON WEBSTER BSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2020
Last Update Date: 11/28/2020
Certification Date: 11/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 8TH ST
CLARKSVILLE TN
37040-3093
US

IV. Provider business mailing address

1523 NOLEN RD APT 844
CLARKSVILLE TN
37040-6987
US

V. Phone/Fax

Practice location:
  • Phone: 931-920-7200
  • Fax:
Mailing address:
  • Phone: 901-378-2123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: