Provider Demographics
NPI:1407527294
Name:COLEBURN, SERENITY
Entity Type:Individual
Prefix:
First Name:SERENITY
Middle Name:
Last Name:COLEBURN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 FLORAL AVE STE 30
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-9143
Mailing Address - Country:US
Mailing Address - Phone:530-893-4784
Mailing Address - Fax:
Practice Address - Street 1:2500 FLORAL AVE STE 30
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-9143
Practice Address - Country:US
Practice Address - Phone:530-893-4784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker