Healthcare Provider Details

I. General information

NPI: 1881502151
Provider Name (Legal Business Name): SERENITY:MIND & BODY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 EDGEFIELD RD STE C1
NORTH AUGUSTA SC
29841-1922
US

IV. Provider business mailing address

1011 RIVER RIDGE DR APT 4I
AUGUSTA GA
30909-2299
US

V. Phone/Fax

Practice location:
  • Phone: 706-339-7526
  • Fax:
Mailing address:
  • Phone: 804-502-2847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHARLENE G GAINEY
Title or Position: THERAPIST
Credential: LISW-CP
Phone: 706-339-7526