| Sel Group | |
|
717 Green Valley Road Suite 200, Office 225 Greensboro NC 27408 | |
| (336) 285-7173 | |
| (336) 285-7174 |
| Full Name | Sel Group |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 717 Green Valley Road, Greensboro, North Carolina |
| Authorized Official Name and Position | Alfonzo Keith Funderburk (PRACTICE ADMINISTRATOR) |
| Authorized Official Contact | 3362857173 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sel Group 1589 Skeet Club Road Suite 102 - Pmb 322 High Point NC 27265 Ph: (336) 285-7173 | Sel Group 717 Green Valley Road Suite 200, Office 225 Greensboro NC 27408 Ph: (336) 285-7173 |
| NPI Number | 1407012966 |
|---|---|
| Provider Enumeration Date | 08/04/2008 |
| Last Update Date | 07/02/2025 |
| Certification Date | 06/11/2025 |
| Medicare PECOS PAC ID | 5092073502 |
|---|---|
| Medicare Enrollment ID | O20171211000414 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407012966 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Nannette Smith Funderburk |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1720131576 PECOS PAC ID: 3072670793 Enrollment ID: I20240223003051 |
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