Provider Demographics
NPI:1184056517
Name:SERENITY THROUGH ENRICHMENT PSYCHOLOGICAL SERVICES, LLC
Entity type:Organization
Organization Name:SERENITY THROUGH ENRICHMENT PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NAKIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY-GOFFNEY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, MA
Authorized Official - Phone:571-723-2321
Mailing Address - Street 1:2915 HUNTER MILL RD
Mailing Address - Street 2:SUITE 14
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-1716
Mailing Address - Country:US
Mailing Address - Phone:571-723-2321
Mailing Address - Fax:
Practice Address - Street 1:2915 HUNTER MILL RD
Practice Address - Street 2:SUITE 14
Practice Address - City:OAKTON
Practice Address - State:VA
Practice Address - Zip Code:22124-1716
Practice Address - Country:US
Practice Address - Phone:571-723-2321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004790103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty