Provider Demographics
NPI:1194423707
Name:SERENITY COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:SERENITY COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYJAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HEDDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-631-7898
Mailing Address - Street 1:44 HUGHES RD STE 1050
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-3046
Mailing Address - Country:US
Mailing Address - Phone:256-631-7898
Mailing Address - Fax:256-542-3366
Practice Address - Street 1:44 HUGHES RD STE 1050
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-3046
Practice Address - Country:US
Practice Address - Phone:256-631-7898
Practice Address - Fax:256-542-3366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
1992173439OtherMENTAL HEALTH