Healthcare Provider Details

I. General information

NPI: 1457073470
Provider Name (Legal Business Name): SERENITY TREE SENOIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2022
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 SHAKERAG HL STE 314
PEACHTREE CITY GA
30269-6523
US

IV. Provider business mailing address

6000 SHAKERAG HL STE 314
PEACHTREE CITY GA
30269-6523
US

V. Phone/Fax

Practice location:
  • Phone: 678-519-8820
  • Fax:
Mailing address:
  • Phone: 678-519-8820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. NATALIE KOHLHAAS
Title or Position: OWNER
Credential: LPC
Phone: 404-542-3502