Provider Demographics
NPI:1538834122
Name:SERENITY THERAPEUTIC SERVICES LLC
Entity type:Organization
Organization Name:SERENITY THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LEAD THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:EBONY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-730-5500
Mailing Address - Street 1:3590B PELHAM PKWY STE 217
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-2034
Mailing Address - Country:US
Mailing Address - Phone:205-730-5500
Mailing Address - Fax:
Practice Address - Street 1:2163 MONTGOMERY HWY STE 212
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124-1160
Practice Address - Country:US
Practice Address - Phone:205-730-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty