Provider Demographics
NPI:1952831158
Name:SERENITY COUNSELING SERVICES
Entity Type:Organization
Organization Name:SERENITY COUNSELING SERVICES
Other - Org Name:SERENITY COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:MCWILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:980-318-7046
Mailing Address - Street 1:1213 ALSTON HILL DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28214-8978
Mailing Address - Country:US
Mailing Address - Phone:980-222-4824
Mailing Address - Fax:980-217-0024
Practice Address - Street 1:5232 MARGARET WALLACE RD
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-2110
Practice Address - Country:US
Practice Address - Phone:980-222-4824
Practice Address - Fax:980-217-0024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-20
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC008336251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC17102610888OtherBLUE CROSS BLUE SHIELD