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General NPI Number Information
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NPI Number | 1518499508
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Entity Type | Organization
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Legal Business Name | SERENITY & GRACE THERAPEUTIC SERVICES
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Dates
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Enumeration Date | 03/30/2017
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Last Update Date | 03/30/2017
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Provider Practice Location Address
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Address Line | 1788 HERITAGE CENTER DR SUITE 202
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City | WAKE FOREST
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State | NC
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Zip | 27587-3948
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Country | US
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Telephone | 919-621-5812
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Fax | 919-516-0088
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Provider Business Mailing Address
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Address Line | 621 MIDDLE BRIDGE RD
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City | WAKE FOREST
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State | NC
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Zip | 27587-2670
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. SARAH HARRIS
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Credential | L.M.F.T., R.P.T.
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Telephone | 919-621-5812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1542
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License Number State | NC
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