Provider Demographics
NPI:1528406626
Name:SERENITY COUNSELING & RESOURCE CENTER
Entity Type:Organization
Organization Name:SERENITY COUNSELING & RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/CLINICAL DIRECTO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:CUTHRELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC, LCAS
Authorized Official - Phone:336-617-9810
Mailing Address - Street 1:4925 W MARKET ST
Mailing Address - Street 2:SUITE 1113 & 1114
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-1544
Mailing Address - Country:US
Mailing Address - Phone:336-617-8910
Mailing Address - Fax:
Practice Address - Street 1:4925 W MARKET ST
Practice Address - Street 2:SUITE 1113 & 1114
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-1544
Practice Address - Country:US
Practice Address - Phone:336-617-8910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8303008Medicaid