Provider Demographics
NPI:1578674057
Name:MICHAEL AVANT
Entity Type:Organization
Organization Name:MICHAEL AVANT
Other - Org Name:SERENITY COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:AVANT
Authorized Official - Suffix:
Authorized Official - Credentials:LCAS, CCS, DAPA, PHD
Authorized Official - Phone:919-603-1655
Mailing Address - Street 1:PO BOX 646
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-0646
Mailing Address - Country:US
Mailing Address - Phone:919-603-1655
Mailing Address - Fax:
Practice Address - Street 1:146 MAIN ST
Practice Address - Street 2:SUITE 209 FEDERAL BUILDING
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-3369
Practice Address - Country:US
Practice Address - Phone:919-603-1655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-039-030101YA0400X, 101YM0800X, 103T00000X, 103TA0400X, 103TP2701X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005322Medicaid
NC017PJOtherBCBS
NC1314WOtherBCBS
NC6110505Medicaid