Provider Demographics
NPI:1760042634
Name:SERENITY COMPREHENSIVE SOLUTIONS, LLC
Entity Type:Organization
Organization Name:SERENITY COMPREHENSIVE SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MENTAL HEALTH CONSULTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-608-7463
Mailing Address - Street 1:9600 PERIMETER STATION DR APT 105
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-4481
Mailing Address - Country:US
Mailing Address - Phone:704-608-7463
Mailing Address - Fax:704-919-0003
Practice Address - Street 1:26 GARDEN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-1716
Practice Address - Country:US
Practice Address - Phone:704-608-7463
Practice Address - Fax:704-919-0003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)