Provider Demographics
NPI:1629748785
Name:SERENE LIFE COUNSELING & WELLNESS, PLLC
Entity Type:Organization
Organization Name:SERENE LIFE COUNSELING & WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHALANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMFT
Authorized Official - Phone:919-335-5601
Mailing Address - Street 1:2501 ENGLISH ROSE LN APT 106
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-6893
Mailing Address - Country:US
Mailing Address - Phone:919-579-1449
Mailing Address - Fax:
Practice Address - Street 1:3061 BERKS WAY STE 201
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-6779
Practice Address - Country:US
Practice Address - Phone:919-335-5601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-20
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1861907974OtherNPPES