MEDICARE: SELAH COUNSELING SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1932050747
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SELAH COUNSELING SERVICES

Provider Business Mailing Address
First Line	:	96 MOONEFIELD DR
Second Line	:
City	:	SMITHFIELD
State	:	VA
Zip	:	23430-1640
Country	:	US
Telephone Number	:	757-346-2316
Fax Number	:	757-866-5603

Provider Business Practice Location Address
First Line	:	301 CONCOURSE BLVD STE 230
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-5643
Country	:	US
Telephone Number	:	757-346-2316
Fax Number	:	757-866-5603

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. AMANDA HICKERSON
Credential	:	LPC, LCMHCS
Telephone Number	:	757-346-2316

Provider Enumeration Date	:	02/06/2026
Last Update Date	:	02/06/2026

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