Provider Demographics
NPI:1497315618
Name:SERENITY HEALTH & WELLNESS, LLC
Entity Type:Organization
Organization Name:SERENITY HEALTH & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LANESHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:912-550-8838
Mailing Address - Street 1:PO BOX 561
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31502-0561
Mailing Address - Country:US
Mailing Address - Phone:912-550-8838
Mailing Address - Fax:
Practice Address - Street 1:702 OSSIE DAVIS PKWY
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-4656
Practice Address - Country:US
Practice Address - Phone:912-550-8838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty