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General NPI Number Information
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NPI Number | 1902974207
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Entity Type | Organization
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Legal Business Name | SELECTIVE CHOICES FOR SERVICES, INC.
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1001 SOUTH MARSHALL STREET BOX 8
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City | WINSTON-SALEM
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State | NC
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Zip | 27101-5401
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Country | US
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Telephone | 336-723-4222
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Fax | 336-723-4238
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Provider Business Mailing Address
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Address Line | 1001 SOUTH MARSHALL STREET BOX 8
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City | WINSTON-SALEM
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State | NC
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Zip | 27101-5401
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Country | US
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Telephone | 336-723-4222
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Fax | 336-723-4238
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MR. ROCHESTER C. DAMON JR.
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Credential | QMHP
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Telephone | 336-971-6535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | NC
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