Provider Demographics
NPI:1346014966
Name:PERRY, SERENA D (PEER RECOVERY SUPPOR)
Entity Type:Individual
Prefix:
First Name:SERENA
Middle Name:D
Last Name:PERRY
Suffix:
Gender:F
Credentials:PEER RECOVERY SUPPOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5433 INLET DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-6313
Mailing Address - Country:US
Mailing Address - Phone:614-702-4324
Mailing Address - Fax:
Practice Address - Street 1:5433 INLET DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-6313
Practice Address - Country:US
Practice Address - Phone:614-702-4324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.004599175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty