MEDICARE: SERENITY PROMISE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1265925648
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY PROMISE

Provider Business Mailing Address
First Line	:	4540 COCHISE TRL
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23237-2559
Country	:	US
Telephone Number	:	804-439-2206
Fax Number	:	858-365-5616

Provider Business Practice Location Address
First Line	:	2430 SOUTHLAND DR STE 7
Second Line	:
City	:	CHESTER
State	:	VA
Zip	:	23831-2354
Country	:	US
Telephone Number	:	804-439-2206
Fax Number	:	804-743-2591

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. SONYA BONITA WEAVER
Credential	:	PMHNP
Telephone Number	:	804-439-2206

Provider Enumeration Date	:	06/11/2018
Last Update Date	:	10/27/2025

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Directions to “SERENITY PROMISE ” Practice Location

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