Healthcare Provider Details

I. General information

NPI: 1306637947
Provider Name (Legal Business Name): SERENITY PATHWAY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16701 MELFORD BLVD STE 400
BOWIE MD
20715-4411
US

IV. Provider business mailing address

7611 CRAIN HWY # 20772
UPPER MARLBORO MD
20772-4258
US

V. Phone/Fax

Practice location:
  • Phone: 240-486-6173
  • Fax:
Mailing address:
  • Phone: 337-349-9849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: MRS. OYINDAMOLA DUNTOYE SIMIEN
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 337-349-9849