Healthcare Provider Details

I. General information

NPI: 1831829118
Provider Name (Legal Business Name): SERENITY HEALING COUNSELING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7132 CAPRI ST
PORTAGE MI
49002-9415
US

IV. Provider business mailing address

7132 CAPRI ST
PORTAGE MI
49002-9415
US

V. Phone/Fax

Practice location:
  • Phone: 269-567-8127
  • Fax:
Mailing address:
  • Phone: 269-567-8127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: LATIECA WILLIAMS
Title or Position: OWNER
Credential: LMSW
Phone: 269-567-8127