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General NPI Number Information
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NPI Number | 1790238152
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Entity Type | Individual
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Provider Name | SERENA MARIE MAREZ M.S., LADC, LPCC
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Gender | Female
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Dates
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Enumeration Date | 08/02/2016
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Last Update Date | 12/20/2022
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Provider Practice Location Address
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Address Line | 6341 UNIVERSITY AVE NE
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City | MINNEAPOLIS
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State | MN
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Zip | 55432-4946
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Country | US
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Telephone | 612-672-6999
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 WASHBURN AVE N
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City | MINNEAPOLIS
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State | MN
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Zip | 55411-2331
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 305743
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0001021
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0014953
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License Number State | CO
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPP.0001433
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License Number State | CO
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Taxonomy #5
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | CC02675
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License Number State | MN
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