Provider Demographics
NPI:1124862404
Name:SHORE SERENITY COUNSELING & WELLNESS
Entity type:Organization
Organization Name:SHORE SERENITY COUNSELING & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHORES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:443-944-3417
Mailing Address - Street 1:501 E NAYLOR MILL RD UNIT C
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-2278
Mailing Address - Country:US
Mailing Address - Phone:443-696-8733
Mailing Address - Fax:
Practice Address - Street 1:501 E NAYLOR MILL RD UNIT C
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-2278
Practice Address - Country:US
Practice Address - Phone:443-696-8733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-21
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty