Provider Demographics
NPI:1437691060
Name:SERENITY COAST COUNSELING LLC
Entity Type:Organization
Organization Name:SERENITY COAST COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:REGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-334-5233
Mailing Address - Street 1:12320 ASHLEY DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-2550
Mailing Address - Country:US
Mailing Address - Phone:228-334-5233
Mailing Address - Fax:
Practice Address - Street 1:12320 ASHLEY DR
Practice Address - Street 2:SUITE D
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-2550
Practice Address - Country:US
Practice Address - Phone:228-334-5233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC78701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty