Provider Demographics
NPI:1437606902
Name:MILLER, SELENA MICHELLE (LCSW)
Entity type:Individual
Prefix:
First Name:SELENA
Middle Name:MICHELLE
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2057 VALLEYDALE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-2712
Mailing Address - Country:US
Mailing Address - Phone:205-732-5072
Mailing Address - Fax:
Practice Address - Street 1:2057 VALLEYDALE RD STE 101
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-2712
Practice Address - Country:US
Practice Address - Phone:205-732-5072
Practice Address - Fax:205-975-8950
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3914C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical