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General NPI Number Information
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NPI Number | 1902663172
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Entity Type | Organization
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Legal Business Name | SERENITY HAVEN RECOVERY
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Dates
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Enumeration Date | 03/04/2024
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Last Update Date | 03/04/2024
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Provider Practice Location Address
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Address Line | 4734 LIDDELL SHORTCUT RD
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City | SEVEN SPRINGS
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State | NC
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Zip | 28578-9469
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Country | US
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Telephone | 336-402-1527
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Fax |
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Provider Business Mailing Address
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Address Line | 4734 LIDDELL SHORTCUT RD
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City | SEVEN SPRINGS
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State | NC
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Zip | 28578-9469
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Country | US
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Telephone | 336-402-1527
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MR. MELISSA ANN GOYEN
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Credential | LQMHP, LCAS, CCS-I
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Telephone | 336-402-1527
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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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 |
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License Number State |
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