Healthcare Provider Details

I. General information

NPI: 1780345447
Provider Name (Legal Business Name): SERENITY PSYCHOTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2022
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 HALL ST SW STE 185G
GRAND RAPIDS MI
49503-5098
US

IV. Provider business mailing address

49 HUCKLEBERRY RD
EAST HARTFORD CT
06118-3543
US

V. Phone/Fax

Practice location:
  • Phone: 616-900-9020
  • Fax:
Mailing address:
  • Phone:
  • 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: SARAH SAUNDERS
Title or Position: LMSW, LCSW
Credential:
Phone: 248-444-7424