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General NPI Number Information
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NPI Number | 1295258101
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Entity Type | Organization
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Legal Business Name | SERENITY PSYCHOTHERAPY LLC
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Dates
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Enumeration Date | 07/23/2017
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 5095 BEATLINE RD
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City | LONG BEACH
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State | MS
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Zip | 39560-3814
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Country | US
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Telephone | 228-365-2317
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Fax |
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Provider Business Mailing Address
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Address Line | 222 BOGGS CIR
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City | LONG BEACH
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State | MS
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Zip | 39560-5807
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Country | US
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Telephone | 228-365-2317
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Fax |
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Authorized Official
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Title or Position | THERAPIST/ OWNER
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Name | MS. HEATHER W BLACK
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Credential | LCSW
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Telephone | 228-365-2317
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C5680
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License Number State | MS
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