MEDICARE: SERENITY COUNSELING 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	101YP2500X	Professional Counselor	0701006017	VA

General Provider Information

NPI Number	:	1639559800
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY COUNSELING LLC

Provider Business Mailing Address
First Line	:	500 WASHINGTON ST
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23704-3508
Country	:	US
Telephone Number	:	757-372-7868
Fax Number	:	757-419-5365

Provider Business Practice Location Address
First Line	:	500 WASHINGTON ST
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23704-3508
Country	:	US
Telephone Number	:	757-372-7868
Fax Number	:	757-419-5365

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	ANGELA CALLAHAN
Credential	:	LPC, NCC
Telephone Number	:	757-372-7868

Provider Enumeration Date	:	06/03/2015
Last Update Date	:	06/03/2015

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