Provider Demographics
NPI:1164771085
Name:SERENITY COUNSELING & RESOURCE CENTER
Entity Type:Organization
Organization Name:SERENITY COUNSELING & RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:CUTHRELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:336-617-8910
Mailing Address - Street 1:2211 W MEADOWVIEW ROAD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-3408
Mailing Address - Country:US
Mailing Address - Phone:336-617-8910
Mailing Address - Fax:
Practice Address - Street 1:1710 WESTBROOK AVENUE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8721
Practice Address - Country:US
Practice Address - Phone:336-617-8910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3410111Medicaid