MEDICARE: SERENITY COUNSELING & RESOURCE CENTER

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1558663070
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY COUNSELING & RESOURCE CENTER

Provider Business Mailing Address
First Line	:	606 BRITTANY CT
Second Line	:
City	:	GIBSONVILLE
State	:	NC
Zip	:	27249-2234
Country	:	US
Telephone Number	:	336-617-8910
Fax Number	:

Provider Business Practice Location Address
First Line	:	2211 W MEADOWVIEW RD STE 10
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-3400
Country	:	US
Telephone Number	:	336-617-8910
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. KIMBERLY M. CUTHRELL
Credential	:	LPC, CCSOTS, PHD
Telephone Number	:	336-617-8910

Provider Enumeration Date	:	12/03/2010
Last Update Date	:	05/06/2011

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