Healthcare Provider Details

I. General information

NPI: 1598493694
Provider Name (Legal Business Name): MEREDITH LEE SERBANICA DNP, APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 HAMPTON DR
NORTH AUGUSTA SC
29860-9422
US

IV. Provider business mailing address

676 HAMPTON DR
NORTH AUGUSTA SC
29860-9422
US

V. Phone/Fax

Practice location:
  • Phone: 619-993-4049
  • Fax: 619-326-3960
Mailing address:
  • Phone: 619-993-4049
  • Fax: 619-326-3960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number28990
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024195271
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95021850
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: