=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457077323
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SERENITY COUNSELING OF WEST ALABAMA, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2022
-----------------------------------------------------
Last Update Date | 10/12/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 423 SKYLAND BLVD STE A7
-----------------------------------------------------
City | TUSCALOOSA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35405-4000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-202-0724
-----------------------------------------------------
Fax | 205-469-9343
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10701 MELROSE LN
-----------------------------------------------------
City | COTTONDALE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35453-2363
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-393-7713
-----------------------------------------------------
Fax | 205-469-9343
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ THERAPIST/ SOCIAL WORKER
-----------------------------------------------------
Name | MRS. JENNIFER ROSE RHODES
-----------------------------------------------------
Credential | LICSW
-----------------------------------------------------
Telephone | 205-393-7713
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------