Provider Demographics
NPI:1295951333
Name:COUNTRY SERENITY COUNSELING LLC
Entity type:Organization
Organization Name:COUNTRY SERENITY COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MARSH NICCUM
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:812-667-2978
Mailing Address - Street 1:10603 SOUTHFORK RD
Mailing Address - Street 2:
Mailing Address - City:DILLSBORO
Mailing Address - State:IN
Mailing Address - Zip Code:47018-8853
Mailing Address - Country:US
Mailing Address - Phone:812-667-2978
Mailing Address - Fax:
Practice Address - Street 1:10603 SOUTHFORK RD
Practice Address - Street 2:
Practice Address - City:DILLSBORO
Practice Address - State:IN
Practice Address - Zip Code:47018-8853
Practice Address - Country:US
Practice Address - Phone:812-667-2978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty