Healthcare Provider Details

I. General information

NPI: 1356976138
Provider Name (Legal Business Name): SERENITY COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2020
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3946 WARWICK DR
VALDOSTA GA
31605-6109
US

IV. Provider business mailing address

3946 WARWICK DR
VALDOSTA GA
31605-6109
US

V. Phone/Fax

Practice location:
  • Phone: 229-343-1822
  • Fax:
Mailing address:
  • Phone: 229-343-1822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. AMANDA J LEE DEGNER
Title or Position: OWNER
Credential:
Phone: 229-343-1822