Provider Demographics
NPI:1477889749
Name:SERENITY COMMUNITY SERVICES
Entity Type:Organization
Organization Name:SERENITY COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:PONDER-WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:770-892-3200
Mailing Address - Street 1:4405 MALL BLVD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:UNION CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30291-2044
Mailing Address - Country:US
Mailing Address - Phone:770-892-3200
Mailing Address - Fax:
Practice Address - Street 1:4405 MALL BOULEVARD
Practice Address - Street 2:SUITE 310
Practice Address - City:UNION CITY
Practice Address - State:USA
Practice Address - Zip Code:USA
Practice Address - Country:UM
Practice Address - Phone:770-892-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-21
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health