Healthcare Provider Details

I. General information

NPI: 1033810312
Provider Name (Legal Business Name): SERENITY'S PLACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8666 THOMAS RD
RIVERDALE GA
30274-5193
US

IV. Provider business mailing address

8666 THOMAS RD
RIVERDALE GA
30274-5193
US

V. Phone/Fax

Practice location:
  • Phone: 140-455-2315
  • Fax:
Mailing address:
  • Phone: 140-455-2315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KINDRA BATTLES
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 140-455-2315