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General NPI Number Information
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NPI Number | 1437691060
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Entity Type | Organization
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Legal Business Name | SERENITY COAST COUNSELING LLC
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Dates
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Enumeration Date | 11/14/2016
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Last Update Date | 11/14/2016
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Provider Practice Location Address
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Address Line | 12320 ASHLEY DR SUITE D
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City | GULFPORT
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State | MS
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Zip | 39503-2550
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Country | US
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Telephone | 228-334-5233
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Fax |
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Provider Business Mailing Address
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Address Line | 12320 ASHLEY DR SUITE D
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City | GULFPORT
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State | MS
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Zip | 39503-2550
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Country | US
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Telephone | 228-334-5233
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | HOLLY REGAN
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Credential |
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Telephone | 228-334-5233
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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 | C7870
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License Number State | MS
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