Provider Demographics
NPI:1902663172
Name:SERENITY HAVEN RECOVERY
Entity type:Organization
Organization Name:SERENITY HAVEN RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GOYEN
Authorized Official - Suffix:
Authorized Official - Credentials:LQMHP, LCAS, CCS-I
Authorized Official - Phone:336-402-1527
Mailing Address - Street 1:4734 LIDDELL SHORTCUT RD
Mailing Address - Street 2:
Mailing Address - City:SEVEN SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28578-9469
Mailing Address - Country:US
Mailing Address - Phone:336-402-1527
Mailing Address - Fax:
Practice Address - Street 1:4734 LIDDELL SHORTCUT RD
Practice Address - Street 2:
Practice Address - City:SEVEN SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:28578-9469
Practice Address - Country:US
Practice Address - Phone:336-402-1527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty