MEDICARE: SERENITY COUNSELING & RESOURCE CENTER

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	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528406626
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY COUNSELING & RESOURCE CENTER

Provider Business Mailing Address
First Line	:	4925 W MARKET ST
Second Line	:	SUITE 1113 & 1114
City	:	GREENSBORO
State	:	NC
Zip	:	27407-1544
Country	:	US
Telephone Number	:	336-617-8910
Fax Number	:

Provider Business Practice Location Address
First Line	:	4925 W MARKET ST
Second Line	:	SUITE 1113 & 1114
City	:	GREENSBORO
State	:	NC
Zip	:	27407-1544
Country	:	US
Telephone Number	:	336-617-8910
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR/CLINICAL DIRECTO
Name	:	KIMBERLY M CUTHRELL
Credential	:	PH.D., LPC, LCAS
Telephone Number	:	336-617-9810

Provider Enumeration Date	:	06/11/2013
Last Update Date	:	06/11/2013

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