Provider Demographics
NPI:1093229700
Name:SERENITY COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:SERENITY COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NICKIE
Authorized Official - Middle Name:CHALONDA
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:803-774-6892
Mailing Address - Street 1:529 OXFORD ST STE B
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-3301
Mailing Address - Country:US
Mailing Address - Phone:803-774-0147
Mailing Address - Fax:803-774-0149
Practice Address - Street 1:529 OXFORD ST STE B
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-3301
Practice Address - Country:US
Practice Address - Phone:803-774-0147
Practice Address - Fax:803-774-0149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6260101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty