Provider Demographics
NPI:1629433248
Name:SERENITY WORKFORCE DEVELOPMENT INSTITUTE
Entity Type:Organization
Organization Name:SERENITY WORKFORCE DEVELOPMENT INSTITUTE
Other - Org Name:SERENITY WORKFORCE DEVELOPMENT INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROOSEVELT
Authorized Official - Middle Name:
Authorized Official - Last Name:COHENS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW,LICSW,LPC
Authorized Official - Phone:202-373-2853
Mailing Address - Street 1:1718 5TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-1818
Mailing Address - Country:US
Mailing Address - Phone:202-373-2853
Mailing Address - Fax:202-506-3712
Practice Address - Street 1:1629 K ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-1602
Practice Address - Country:US
Practice Address - Phone:202-373-2853
Practice Address - Fax:202-506-3712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-26
Last Update Date:2015-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC50080419302R00000X, 305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No305R00000XManaged Care OrganizationsPreferred Provider Organization