Provider Demographics
NPI:1669650503
Name:SERENITY COUNSELING & RESOURCE CENTER, INC
Entity Type:Organization
Organization Name:SERENITY COUNSELING & RESOURCE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTCHIEF EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:CUTHRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-287-7929
Mailing Address - Street 1:1510 MARTIN ST STE 103
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-4931
Mailing Address - Country:US
Mailing Address - Phone:336-287-7929
Mailing Address - Fax:336-287-7929
Practice Address - Street 1:1510 MARTIN ST STE 103
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4931
Practice Address - Country:US
Practice Address - Phone:336-287-7929
Practice Address - Fax:336-287-7929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6709101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6006320Medicaid