MEDICARE: SERENITY BEHAVIORAL THERAPIES, PLLC

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	:	1821879057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY BEHAVIORAL THERAPIES, PLLC

Provider Business Mailing Address
First Line	:	200 VALENCIA DR STE 162
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-6314
Country	:	US
Telephone Number	:	910-381-3010
Fax Number	:	910-378-7931

Provider Business Practice Location Address
First Line	:	200 VALENCIA DR STE 162
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-6314
Country	:	US
Telephone Number	:	910-381-3010
Fax Number	:	910-378-7931

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	MRS. JAMESZETTA THOMPSON HARDISON
Credential	:	MA, LPA, LMFT
Telephone Number	:	910-381-3010

Provider Enumeration Date	:	10/12/2023
Last Update Date	:	10/12/2023

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