Organization Name: | COUNTRY SERENITY COUNSELING LLC |
NPI Number: | 1295951333 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DEBRA MARIE MARSH NICCUM (OWNER COUNSELOR) |
Mailing Address: | 10603 Southfork Rd Dillsboro |
State: | IN US |
Postal Code: | 470188853 |
Phone Number: | 8126672978 |
Fax Number: | |
NPI Enumeration Date: | 04/17/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |