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General NPI Number Information
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NPI Number | 1164011979
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Entity Type | Organization
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Legal Business Name | INNER SERENITY COUNSELING LLC
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Dates
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Enumeration Date | 01/15/2021
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Last Update Date | 01/15/2021
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Provider Practice Location Address
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Address Line | 7545 CENTURION PKWY STE 206
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City | JACKSONVILLE
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State | FL
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Zip | 32256-4119
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Country | US
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Telephone | 904-683-0418
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Fax | 904-595-6815
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Provider Business Mailing Address
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Address Line | 7545 CENTURION PKWY STE 206
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City | JACKSONVILLE
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State | FL
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Zip | 32256-4119
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Country | US
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Telephone | 904-683-0418
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Fax | 904-595-6815
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Authorized Official
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Title or Position | OWNER
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Name | RAJA BASHITI
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Credential | LMHC
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Telephone | 904-683-0418
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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