=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265946750
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SERENE SOLUTIONS COUNSELING & CONSULTING SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2017
-----------------------------------------------------
Last Update Date | 11/27/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3975 UNIVERSITY DR STE 210
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22030-2534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-267-5704
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3975 UNIVERSITY DR STE 210
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22030-2534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-267-5704
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CLINICIAN
-----------------------------------------------------
Name | MS. SHARNECE AYANA THOMAS
-----------------------------------------------------
Credential | MA, NCC, LPC, LCPC
-----------------------------------------------------
Telephone | 703-267-5704
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------