Provider Demographics
NPI:1508631375
Name:SERENITY PSYCHIATRIC AND MENTAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:SERENITY PSYCHIATRIC AND MENTAL HEALTH SERVICES LLC
Other - Org Name:SERENITY PSYCHIATRIC AND MENTAL HEALTH SERVICES LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHIATRIC MENTAL HEALTH PROVIDER
Authorized Official - Prefix:MISS
Authorized Official - First Name:HENRIETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAGOE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:301-812-4540
Mailing Address - Street 1:13017 WISTERIA DR STE 114
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-2621
Mailing Address - Country:US
Mailing Address - Phone:301-812-4540
Mailing Address - Fax:301-238-7850
Practice Address - Street 1:12800 MIDDLEBROOK RD STE 400
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-5282
Practice Address - Country:US
Practice Address - Phone:301-812-4540
Practice Address - Fax:301-812-4540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-21
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty