Provider Demographics
NPI:1821595463
Name:SERENITY FIRST COUNSELING, A NON-PROFIT CORPORATION
Entity Type:Organization
Organization Name:SERENITY FIRST COUNSELING, A NON-PROFIT CORPORATION
Other - Org Name:SERENITY FIRST COUNSELING, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ORGANIZER, DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SILVER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:520-398-7272
Mailing Address - Street 1:136 W VUELTA FRISO
Mailing Address - Street 2:
Mailing Address - City:SAHUARITA
Mailing Address - State:AZ
Mailing Address - Zip Code:85629-8672
Mailing Address - Country:US
Mailing Address - Phone:818-371-7463
Mailing Address - Fax:
Practice Address - Street 1:170 N LA CANADA DR STE 30C
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-3139
Practice Address - Country:US
Practice Address - Phone:520-398-7272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-10
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-10027101YA0400X
AZLCSW-104701041C0700X
AZLMFT-10221106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty