Healthcare Provider Details

I. General information

NPI: 1255757092
Provider Name (Legal Business Name): SERENITY REHABILITATION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2014
Last Update Date: 03/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11205 LAWYERS RD SUITE F
MINT HILL NC
28227-8306
US

IV. Provider business mailing address

2216 W MEADOWVIEW RD SUITE 120
GREENSBORO NC
27407-3406
US

V. Phone/Fax

Practice location:
  • Phone: 980-226-5590
  • Fax:
Mailing address:
  • Phone: 336-471-8130
  • Fax: 336-464-2932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SHAWANA TORRENCE
Title or Position: CEO
Credential:
Phone: 336-471-8130