Provider Demographics
NPI:1720298904
Name:SERRENO, COLLEEN MARY (LPC, LCAS)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:MARY
Last Name:SERRENO
Suffix:
Gender:F
Credentials:LPC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9023 STOURBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-9792
Mailing Address - Country:US
Mailing Address - Phone:704-875-1264
Mailing Address - Fax:
Practice Address - Street 1:9023 STOURBRIDGE DR
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-9792
Practice Address - Country:US
Practice Address - Phone:704-875-1264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3977101Y00000X
NC1132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)