Healthcare Provider Details

I. General information

NPI: 1972184109
Provider Name (Legal Business Name): SERENITY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 BEAVERTAIL DR
BRUCETON MILLS WV
26525-5859
US

IV. Provider business mailing address

5301 E FERRY RD
GLADYS VA
24554-3253
US

V. Phone/Fax

Practice location:
  • Phone: 812-629-3994
  • Fax:
Mailing address:
  • Phone: 812-629-3994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MINDY EAVES
Title or Position: OWNER
Credential: LPC
Phone: 812-629-3994