Healthcare Provider Details

I. General information

NPI: 1881485571
Provider Name (Legal Business Name): SERENITY CLINICAL COUNSELING AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1077 ACACIA LN
COLUMBIA SC
29229-7063
US

IV. Provider business mailing address

1077 ACACIA LN
COLUMBIA SC
29229-7063
US

V. Phone/Fax

Practice location:
  • Phone: 601-624-3069
  • Fax:
Mailing address:
  • Phone: 601-624-3069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHAVEN ABNEY SMITH
Title or Position: THERAPIST
Credential: LCSW
Phone: 601-624-3069