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General NPI Number Information
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NPI Number | 1922528116
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Entity Type | Individual
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Provider Name | MS. SERENA SOUKSAKHONE MOUA
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Gender | Female
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Dates
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Enumeration Date | 06/20/2017
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 5201 GREAT AMERICA PKWY STE 320
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City | SANTA CLARA
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State | CA
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Zip | 95054-1140
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Country | US
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Telephone | 323-205-7088
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Fax | 833-419-0181
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Provider Business Mailing Address
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Address Line | PO BOX 4874
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City | FRESNO
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State | CA
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Zip | 93744-4874
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Country | US
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Telephone | 323-205-7088
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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 | R1324030918
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 131062
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 156502
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License Number State | CA
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