Healthcare Provider Details

I. General information

NPI: 1457282345
Provider Name (Legal Business Name): SERENITY SPACE BY LXC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8050 PHILADELPHIA RD
BALTIMORE MD
21237-2638
US

IV. Provider business mailing address

8050 PHILADELPHIA RD
BALTIMORE MD
21237-2638
US

V. Phone/Fax

Practice location:
  • Phone: 443-468-0345
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ALEXIS SIMPSON
Title or Position: FOUNDER & CEO
Credential: MSN, PMHNP
Phone: 443-468-0345