Provider Demographics
NPI:1174034581
Name:SERENITY COUNSELING PROFESSIONALS, LLP
Entity Type:Organization
Organization Name:SERENITY COUNSELING PROFESSIONALS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARION
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MS
Authorized Official - Phone:334-356-4272
Mailing Address - Street 1:8136 OLD FEDERAL RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-8007
Mailing Address - Country:US
Mailing Address - Phone:334-356-4272
Mailing Address - Fax:
Practice Address - Street 1:8136 OLD FEDERAL RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-8007
Practice Address - Country:US
Practice Address - Phone:334-356-4272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-12
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL201700215261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)