Provider Demographics
NPI:1265925648
Name:SERENITY PROMISE
Entity type:Organization
Organization Name:SERENITY PROMISE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:B
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:804-439-2206
Mailing Address - Street 1:4540 COCHISE TRL
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23237-2559
Mailing Address - Country:US
Mailing Address - Phone:804-439-2206
Mailing Address - Fax:804-743-2591
Practice Address - Street 1:2430 SOUTHLAND DR STE 7
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-2354
Practice Address - Country:US
Practice Address - Phone:804-439-2206
Practice Address - Fax:804-743-2591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-11
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1578051801Medicaid