MEDICARE: SERENITY COUNSELING CENTER, 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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1720671126
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY COUNSELING CENTER, LLC

Provider Business Mailing Address
First Line	:	2210 EVERLEIGH DR
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30064-2652
Country	:	US
Telephone Number	:	404-369-0816
Fax Number	:	470-523-4415

Provider Business Practice Location Address
First Line	:	50 WHITLOCK PL SW STE 350
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30064-3164
Country	:	US
Telephone Number	:	404-369-0816
Fax Number	:	470-523-4415

Authorized Official
Title or Position	:	FOUNDER/DIRECTOR
Name	:	JESSICA RUIZ
Credential	:	LPC
Telephone Number	:	404-369-0816

Provider Enumeration Date	:	02/16/2021
Last Update Date	:	02/16/2021

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