Healthcare Provider Details

I. General information

NPI: 1871318196
Provider Name (Legal Business Name): SERENITY MINDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 S MARION ST
BLOOMVILLE OH
44818-9201
US

IV. Provider business mailing address

54 S MARION ST
BLOOMVILLE OH
44818-9201
US

V. Phone/Fax

Practice location:
  • Phone: 567-207-5377
  • Fax: 888-518-4977
Mailing address:
  • Phone: 567-207-5377
  • Fax: 888-518-4977

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 TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. JESSICA ROHRBACH
Title or Position: OWNER, LPCC, LICDC
Credential: LPCC, LICDC
Phone: 567-207-5377