Provider Demographics
NPI:1427618081
Name:SERENITY PSYCHOTHERAPY, LLC
Entity type:Organization
Organization Name:SERENITY PSYCHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MERCEDES
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOS-BELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-406-6763
Mailing Address - Street 1:3210 CHURCHLAND BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5253
Mailing Address - Country:US
Mailing Address - Phone:757-966-2162
Mailing Address - Fax:
Practice Address - Street 1:3210 CHURCHLAND BLVD STE 2
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5253
Practice Address - Country:US
Practice Address - Phone:757-966-2162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)