Provider Demographics
NPI:1578389912
Name:SERENITY CHRISTIAN COUNSELING
Entity type:Organization
Organization Name:SERENITY CHRISTIAN COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TECKY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RUSK
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC-S
Authorized Official - Phone:567-429-1000
Mailing Address - Street 1:125 S MAIN ST STE 305
Mailing Address - Street 2:
Mailing Address - City:FOSTORIA
Mailing Address - State:OH
Mailing Address - Zip Code:44830-2361
Mailing Address - Country:US
Mailing Address - Phone:567-249-1000
Mailing Address - Fax:
Practice Address - Street 1:125 S MAIN ST STE 305
Practice Address - Street 2:
Practice Address - City:FOSTORIA
Practice Address - State:OH
Practice Address - Zip Code:44830-2361
Practice Address - Country:US
Practice Address - Phone:567-249-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder