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General NPI Number Information
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NPI Number | 1235584806
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Entity Type | Organization
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Legal Business Name | SERENITY'S SOULFUL HEALING WELLNESS COUNSELING & CONSULTATION LLC
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Dates
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Enumeration Date | 05/02/2016
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Last Update Date | 05/02/2016
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Provider Practice Location Address
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Address Line | 229 W MARIETTA ST
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City | WOODSFIELD
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State | OH
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Zip | 43793-1051
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Country | US
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Telephone | 740-472-9022
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Fax |
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Provider Business Mailing Address
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Address Line | 229 W MARIETTA ST P.O. BOX 242
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City | WOODSFIELD
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State | OH
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Zip | 43793-1051
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Country | US
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Telephone | 740-472-9022
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | JOY GRAHAM
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Credential | PCC
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Telephone | 740-472-9022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E0004359
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License Number State | OH
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