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General NPI Number Information
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NPI Number | 1598304834
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Entity Type | Organization
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Legal Business Name | SERENITY THERAPEUTIC COUNSELING PLACE
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Dates
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Enumeration Date | 01/03/2020
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Last Update Date | 01/03/2020
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Provider Practice Location Address
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Address Line | 10852 LEM TURNER RD
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City | JACKSONVILLE
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State | FL
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Zip | 32218-4566
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Country | US
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Telephone | 904-609-0086
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Fax |
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Provider Business Mailing Address
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Address Line | 11653 TURTLE RUN CT
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City | JACKSONVILLE
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State | FL
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Zip | 32219-5127
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Country | US
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Telephone | 904-609-0086
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Fax |
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Authorized Official
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Title or Position | LICENSED MARRIAGE AND FAMILY THERAP
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Name | EBONY MCCRAY-HOLMES
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Credential | LMFT
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Telephone | 904-609-0086
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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