Provider Demographics
NPI:1477126514
Name:SERENITEE COUNSELING & COMMUNITY SERVICES, LLC
Entity Type:Organization
Organization Name:SERENITEE COUNSELING & COMMUNITY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:864-243-8097
Mailing Address - Street 1:3575 RUTHERFORD ROAD EXT STE B
Mailing Address - Street 2:
Mailing Address - City:TAYLORS
Mailing Address - State:SC
Mailing Address - Zip Code:29687-2168
Mailing Address - Country:US
Mailing Address - Phone:864-243-8097
Mailing Address - Fax:
Practice Address - Street 1:3575 RUTHERFORD ROAD EXT STE B
Practice Address - Street 2:
Practice Address - City:TAYLORS
Practice Address - State:SC
Practice Address - Zip Code:29687-2168
Practice Address - Country:US
Practice Address - Phone:864-243-8097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC421504Medicaid