Provider Demographics
NPI:1386274223
Name:SILVERS, SERENITY GRACE MICHELLE (LPCC, LADC)
Entity type:Individual
Prefix:
First Name:SERENITY
Middle Name:GRACE MICHELLE
Last Name:SILVERS
Suffix:
Gender:F
Credentials:LPCC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 GRAND AVE STE 135
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-3002
Mailing Address - Country:US
Mailing Address - Phone:651-419-6967
Mailing Address - Fax:
Practice Address - Street 1:1619 DAYTON AVE STE 325
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6495
Practice Address - Country:US
Practice Address - Phone:763-228-4752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-20
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305765101YA0400X
MN3629101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN305765OtherLICENSED ALCOHOL AND DRUG COUNSELOR
MN3629OtherLICENSED PROFESSIONAL CLINICAL COUNSELOR