Provider Demographics
NPI:1477131068
Name:THE SERENE SHIELD, LLC
Entity Type:Organization
Organization Name:THE SERENE SHIELD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:M ED, LPC, NCC
Authorized Official - Phone:804-691-7624
Mailing Address - Street 1:1021 LEE ROAD 201
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:AL
Mailing Address - Zip Code:36874-4161
Mailing Address - Country:US
Mailing Address - Phone:804-691-7624
Mailing Address - Fax:
Practice Address - Street 1:1021 LEE ROAD 201
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:AL
Practice Address - Zip Code:36874-4161
Practice Address - Country:US
Practice Address - Phone:804-691-7624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)