Healthcare Provider Details

I. General information

NPI: 1104419522
Provider Name (Legal Business Name): SERENITY PLACE INTERVENTION CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2021
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 MINE LAKE CT STE 100
RALEIGH NC
27615-6417
US

IV. Provider business mailing address

140 MINE LAKE CT STE 100
RALEIGH NC
27615-6417
US

V. Phone/Fax

Practice location:
  • Phone: 984-344-7320
  • Fax: 919-518-8295
Mailing address:
  • Phone: 919-847-3309
  • Fax: 919-518-8295

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 Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyY
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 TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. PETER ONUZULIKE SR.
Title or Position: OWNER
Credential:
Phone: 919-847-3309