Healthcare Provider Details

I. General information

NPI: 1396562716
Provider Name (Legal Business Name): SOUTHERN SERENITY COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1579 CEDAR LAKE CIR
HERNANDO MS
38632-6955
US

IV. Provider business mailing address

1579 CEDAR LAKE CIR
HERNANDO MS
38632-6955
US

V. Phone/Fax

Practice location:
  • Phone: 662-614-0719
  • Fax:
Mailing address:
  • Phone: 662-614-0719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: LAURIE COOPER
Title or Position: OWNER, COUNSELOR
Credential: LPC
Phone: 662-614-0719