Provider Demographics
NPI:1730542440
Name:SERENITY, COURAGE, & WISDOM COUNSELING LLC
Entity type:Organization
Organization Name:SERENITY, COURAGE, & WISDOM COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMEKA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEE-GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:757-778-3012
Mailing Address - Street 1:2211 TODDS LN
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-3146
Mailing Address - Country:US
Mailing Address - Phone:757-778-3012
Mailing Address - Fax:
Practice Address - Street 1:2211 TODDS LN
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-3146
Practice Address - Country:US
Practice Address - Phone:757-778-3012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-30
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040072491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1730542440Medicaid