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General NPI Number Information
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NPI Number | 1851773360
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Entity Type | Organization
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Legal Business Name | SERENITY SPACE COUNSELING, PLLC
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Dates
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Enumeration Date | 06/20/2015
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Last Update Date | 08/31/2025
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Provider Practice Location Address
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Address Line | 1122 SAM NEWELL RD STE 110
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City | MATTHEWS
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State | NC
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Zip | 28105-5016
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Country | US
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Telephone | 704-931-8371
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Fax | 877-259-6224
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Provider Business Mailing Address
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Address Line | 1122 SAM NEWELL RD STE 110
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City | MATTHEWS
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State | NC
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Zip | 28105-5016
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Country | US
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Telephone | 704-931-8371
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Fax | 877-259-6224
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | LISA K PADEN
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Credential |
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Telephone | 704-931-8371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C009546
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License Number State | NC
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