Provider Demographics
NPI:1235922972
Name:CONWELL, SELINA
Entity type:Individual
Prefix:
First Name:SELINA
Middle Name:
Last Name:CONWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 5TH ST N STE 3
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:AL
Mailing Address - Zip Code:35121-1575
Mailing Address - Country:US
Mailing Address - Phone:205-207-5688
Mailing Address - Fax:
Practice Address - Street 1:406 5TH ST N STE 3
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:AL
Practice Address - Zip Code:35121-1575
Practice Address - Country:US
Practice Address - Phone:205-207-5688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-26
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC04484101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health