Healthcare Provider Details

I. General information

NPI: 1184033466
Provider Name (Legal Business Name): SERENE HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2014
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 ELM ST STE 200
FAYETTEVILLE NC
28303-4164
US

IV. Provider business mailing address

823 ELM ST STE 200
FAYETTEVILLE NC
28303-4164
US

V. Phone/Fax

Practice location:
  • Phone: 646-588-8176
  • Fax:
Mailing address:
  • Phone: 646-588-8176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CONNIE KERN
Title or Position: CEO
Credential: NCC, LCMHC, NBCR
Phone: 646-588-8176