Healthcare Provider Details

I. General information

NPI: 1467998468
Provider Name (Legal Business Name): SERENITY PLACE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2017
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22655 WASHINGTON ST
LEONARDTOWN MD
20650-3848
US

IV. Provider business mailing address

PO BOX 1831
LEONARDTOWN MD
20650-1831
US

V. Phone/Fax

Practice location:
  • Phone: 301-690-8008
  • Fax:
Mailing address:
  • Phone: 301-690-8008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number16047
License Number StateMD

VIII. Authorized Official

Name: ESTHER VANDERWAL
Title or Position: PRESIDENT
Credential:
Phone: 301-690-8008