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General NPI Number Information
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NPI Number | 1912314246
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Entity Type | Organization
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Legal Business Name | BROOK OF SERENITY THERAPY, LLC
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Dates
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Enumeration Date | 07/18/2014
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 434 FLAT SHOALS AVE SE STE 5
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City | ATLANTA
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State | GA
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Zip | 30316-1915
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Country | US
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Telephone | 832-542-3982
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Fax |
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Provider Business Mailing Address
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Address Line | 1273 METROPOLITAN AVE SE UNIT 160014
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City | ATLANTA
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State | GA
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Zip | 30316-8000
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Country | US
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Telephone | 678-908-8371
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Fax |
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Authorized Official
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Title or Position | PASTORAL CARE COUNSELOR & THERAPIST
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Name | DR. SELENA COLEMAN
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Credential |
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Telephone | 678-908-8371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 09134046
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License Number State | GA
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