Healthcare Provider Details

I. General information

NPI: 1366013484
Provider Name (Legal Business Name): LIFE OF SERENITY PROFESSIONAL COUNSELING SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2021
Last Update Date: 07/09/2021
Certification Date: 07/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 BLUE PINE DR
SPRING LAKE NC
28390-9176
US

IV. Provider business mailing address

35 BLUE PINE DR
SPRING LAKE NC
28390-9176
US

V. Phone/Fax

Practice location:
  • Phone: 336-419-6210
  • Fax:
Mailing address:
  • Phone: 336-419-6210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SASHA SHARMAINE HAMILTON
Title or Position: OWNER
Credential: MSW, LCSW
Phone: 336-419-6210