Healthcare Provider Details

I. General information

NPI: 1871212282
Provider Name (Legal Business Name): SERENITY COUNSELING & WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2022
Last Update Date: 02/25/2023
Certification Date: 02/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

597 OLD MOUNT HOLLY RD STE 203E
GOOSE CREEK SC
29445-2832
US

IV. Provider business mailing address

PO BOX 2814
SUMMERVILLE SC
29484-2814
US

V. Phone/Fax

Practice location:
  • Phone: 843-212-6499
  • Fax:
Mailing address:
  • Phone: 843-212-6499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. CANDRA GILLIARD JAMES
Title or Position: OWNER
Credential: LPC
Phone: 843-212-6499