Provider Demographics
NPI:1932501459
Name:SERENITY AND WELLNESS CLINIC
Entity Type:Organization
Organization Name:SERENITY AND WELLNESS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIET
Authorized Official - Middle Name:ADEBSI
Authorized Official - Last Name:ADETUNJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-640-8231
Mailing Address - Street 1:P.O. BOX 1992
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21203
Mailing Address - Country:US
Mailing Address - Phone:443-640-8231
Mailing Address - Fax:
Practice Address - Street 1:1133 PENNSYLVANIA AVENUE
Practice Address - Street 2:SUITE 204
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-2005
Practice Address - Country:US
Practice Address - Phone:443-640-8231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-17
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty