Provider Demographics
NPI:1639627524
Name:SERENITY HEALING, LLC
Entity Type:Organization
Organization Name:SERENITY HEALING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMYE
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-MHSP
Authorized Official - Phone:423-218-7851
Mailing Address - Street 1:773 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-5858
Mailing Address - Country:US
Mailing Address - Phone:423-218-7851
Mailing Address - Fax:423-926-4327
Practice Address - Street 1:207 N BOONE ST
Practice Address - Street 2:SUITE 17
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-5675
Practice Address - Country:US
Practice Address - Phone:423-926-4327
Practice Address - Fax:423-926-4327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2757101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ022731Medicaid