MEDICARE: THE SERENE SHIELD, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1477131068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE SERENE SHIELD, LLC

Provider Business Mailing Address
First Line	:	1021 LEE ROAD 201
Second Line	:
City	:	SALEM
State	:	AL
Zip	:	36874-4161
Country	:	US
Telephone Number	:	804-691-7624
Fax Number	:

Provider Business Practice Location Address
First Line	:	1021 LEE ROAD 201
Second Line	:
City	:	SALEM
State	:	AL
Zip	:	36874-4161
Country	:	US
Telephone Number	:	804-691-7624
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHELLE SHIELDS
Credential	:	M. ED, LPC, NCC
Telephone Number	:	804-691-7624

Provider Enumeration Date	:	04/01/2021
Last Update Date	:	04/01/2021

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Directions to “THE SERENE SHIELD, LLC ” Practice Location

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