MEDICARE: SEEK YOUR SERENITY COUNSELING CENTER, 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1720622129
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEEK YOUR SERENITY COUNSELING CENTER, LLC

Provider Business Mailing Address
First Line	:	500 WASHINGTON ST STE 2
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 STE 2
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	:	MRS. ANGELA CALLAHAN
Credential	:	MED
Telephone Number	:	757-372-7868

Provider Enumeration Date	:	10/30/2019
Last Update Date	:	10/30/2019

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