Provider Demographics
NPI:1659720266
Name:SERENITY SOLUTIONS COUNSELING AND CONSULTING
Entity Type:Organization
Organization Name:SERENITY SOLUTIONS COUNSELING AND CONSULTING
Other - Org Name:WENDY FREDRICKSON TRUDEAU, LISW-CP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:FREDRICKSON
Authorized Official - Last Name:TRUDEAU
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-CP
Authorized Official - Phone:803-397-5010
Mailing Address - Street 1:130 E RICHARDSON AVE
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-6333
Mailing Address - Country:US
Mailing Address - Phone:803-397-5010
Mailing Address - Fax:866-871-8001
Practice Address - Street 1:130 E RICHARDSON AVE
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6333
Practice Address - Country:US
Practice Address - Phone:803-397-5010
Practice Address - Fax:866-871-8001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-06
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC47011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSW1177Medicaid
SC1174585988OtherINDIVIDUAL PROVIDER NPI
SCQ277920281Medicare PIN