Provider Demographics
NPI:1952718132
Name:DYLAN, SERENITY (LMBT, MMP)
Entity Type:Individual
Prefix:
First Name:SERENITY
Middle Name:
Last Name:DYLAN
Suffix:
Gender:F
Credentials:LMBT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 RIVER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-1095
Mailing Address - Country:US
Mailing Address - Phone:828-808-8955
Mailing Address - Fax:
Practice Address - Street 1:1806 RIVER RIDGE DR
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1095
Practice Address - Country:US
Practice Address - Phone:828-808-8955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-19
Last Update Date:2014-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6352225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist