Provider Demographics
NPI:1922881234
Name:SERENITY MENTAL HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:SERENITY MENTAL HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:TIKEAMA
Authorized Official - Middle Name:LATOYA
Authorized Official - Last Name:BUCKINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:716-548-8644
Mailing Address - Street 1:4410 CLAIBORNE SQ E STE 343
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-2071
Mailing Address - Country:US
Mailing Address - Phone:716-548-8644
Mailing Address - Fax:
Practice Address - Street 1:4410 CLAIBORNE SQ E STE 343
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2071
Practice Address - Country:US
Practice Address - Phone:716-548-8644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center