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General NPI Number Information
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NPI Number | 1912894247
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Entity Type | Organization
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Legal Business Name | SERENITY SPRINGS WELLNESS AND RECOVERY
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Dates
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Enumeration Date | 06/19/2025
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Last Update Date | 06/20/2025
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Provider Practice Location Address
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Address Line | 1003 N 25TH ST
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City | RICHMOND
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State | VA
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Zip | 23223-5236
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Country | US
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Telephone | 804-980-4047
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Fax |
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Provider Business Mailing Address
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Address Line | 3231 COFER RD APT A3231
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City | RICHMOND
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State | VA
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Zip | 23224-6403
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Country | US
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Telephone | 804-980-4047
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Fax | 804-980-4047
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Authorized Official
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Title or Position | COUNSELOR
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Name | DEONTAY LAVAR EASTER
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Credential |
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Telephone | 804-980-4047
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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