Provider Demographics
NPI:1467859595
Name:SERENITY FAMILY AND PSYCHOLOGICAL COUNSELING CENTER, P.C.
Entity Type:Organization
Organization Name:SERENITY FAMILY AND PSYCHOLOGICAL COUNSELING CENTER, P.C.
Other - Org Name:SERENITY TRAUMA HEALING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:G
Authorized Official - Last Name:MEDNICK
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:310-310-9249
Mailing Address - Street 1:881 ALMA REAL DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-3731
Mailing Address - Country:US
Mailing Address - Phone:310-310-9249
Mailing Address - Fax:
Practice Address - Street 1:881 ALMA REAL DR
Practice Address - Street 2:SUITE 310
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-3731
Practice Address - Country:US
Practice Address - Phone:310-310-9249
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36644106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1114268497OtherSERENITY TRAUMA HEALING CENTER INC
CA1295076578OtherJOANNE GAIL MEDNICK LMFT 36644