Provider Demographics
NPI:1437658762
Name:SERENITY CONSULTANTS, LLC
Entity Type:Organization
Organization Name:SERENITY CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELLISHA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:912-247-6482
Mailing Address - Street 1:55 WINSLOW CIR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31407-4946
Mailing Address - Country:US
Mailing Address - Phone:912-247-6482
Mailing Address - Fax:
Practice Address - Street 1:1018 US HIGHWAY 80 W STE 702
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-1606
Practice Address - Country:US
Practice Address - Phone:912-349-2969
Practice Address - Fax:912-349-2983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-01
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0043731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACSW004373OtherGA STATE LICENSE