Healthcare Provider Details

I. General information

NPI: 1679716674
Provider Name (Legal Business Name): SERAPHIM CHILDREN'S THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2009
Last Update Date: 04/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 LITTLE PINEY MTN
CANDLER NC
28715-7813
US

IV. Provider business mailing address

43 LITTLE PINEY MTN
CANDLER NC
28715-7813
US

V. Phone/Fax

Practice location:
  • Phone: 828-423-4090
  • Fax: 828-633-0744
Mailing address:
  • Phone: 828-423-4090
  • Fax: 828-633-0744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6494
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-005631
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7269
License Number StateNC

VIII. Authorized Official

Name: MRS. SARA P MITCHELL
Title or Position: PRESIDENT/OWNER
Credential: M.S., CCC-SLP
Phone: 828-423-4090