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General NPI Number Information
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NPI Number | 1194237958
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Entity Type | Individual
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Provider Name | CORRONA SELENA BOSTON LPC AND ATR
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Gender | Female
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Dates
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Enumeration Date | 11/01/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 3001 BLADENSBURG RD NE STE 100
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City | WASHINGTON
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State | DC
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Zip | 20018-2235
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Country | US
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Telephone | 202-635-3577
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Fax | 202-635-0906
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Provider Business Mailing Address
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Address Line | 17309 NEWTON CT
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City | UPPER MARLBORO
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State | MD
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Zip | 20772-3308
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Country | US
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Telephone | 240-938-1092
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | PRC14506
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License Number State | DC
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