MEDICARE: SERENITYMINDS, LLC

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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1366233595
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITYMINDS, LLC

Provider Business Mailing Address
First Line	:	900 COMMONWEALTH PL STE 219
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-4529
Country	:	US
Telephone Number	:	757-277-3552
Fax Number	:	757-665-2907

Provider Business Practice Location Address
First Line	:	900 COMMONWEALTH PL STE 219
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-4529
Country	:	US
Telephone Number	:	757-277-3552
Fax Number	:	757-665-2907

Authorized Official
Title or Position	:	CEO
Name	:	MR. OLUSEGUN F OSOSANYA
Credential	:	MA. PSYCH
Telephone Number	:	757-277-3552

Provider Enumeration Date	:	05/15/2025
Last Update Date	:	05/15/2025

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Directions to “SERENITYMINDS, LLC ” Practice Location

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