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General NPI Number Information
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NPI Number | 1255144507
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Entity Type | Individual
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Provider Name | SELENA NICOLE CHRISTINE CLARK ALC
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Gender | Female
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Dates
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Enumeration Date | 01/30/2025
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 623 WALNUT ST
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City | GADSDEN
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State | AL
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Zip | 35901-4136
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Country | US
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Telephone | 256-673-4346
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Fax |
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Provider Business Mailing Address
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Address Line | 2114 KILPATRICK LN NW
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City | CULLMAN
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State | AL
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Zip | 35058-1856
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Country | US
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Telephone | 256-706-9855
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | ACC05193
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License Number State | AL
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