Provider Demographics
NPI:1548631740
Name:SERENITY COUNSELING CO
Entity type:Organization
Organization Name:SERENITY COUNSELING CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:CAGER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC
Authorized Official - Phone:404-285-2379
Mailing Address - Street 1:PO BOX 311461
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31131-1461
Mailing Address - Country:US
Mailing Address - Phone:404-285-2379
Mailing Address - Fax:770-234-4134
Practice Address - Street 1:3915 CASCADE ROAD SW
Practice Address - Street 2:SUITE T132
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-6359
Practice Address - Country:US
Practice Address - Phone:770-464-6147
Practice Address - Fax:770-234-4134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-13
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007953101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003123304AMedicaid