=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538920327
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SERENITY WELLNESS & COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2024
-----------------------------------------------------
Last Update Date | 01/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 52E-3 ESTATE THOMAS ST THOMAS
-----------------------------------------------------
City | USVI
-----------------------------------------------------
State | VI
-----------------------------------------------------
Zip | 00802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 340-513-0418
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 302278
-----------------------------------------------------
City | ST THOMAS
-----------------------------------------------------
State | VI
-----------------------------------------------------
Zip | 00803-2278
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 340-513-0418
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED PROFESSIONAL COUNSELOR
-----------------------------------------------------
Name | DR. NOUR SUID
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 340-513-0418
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------