| Serenity Coast Counseling Llc | |
|
12320 Ashley Dr Suite D Gulfport MS 39503-2550 | |
| (228) 334-5233 | |
| Not Available |
| Full Name | Serenity Coast Counseling Llc |
|---|---|
| Speciality | Social Worker |
| Location | 12320 Ashley Dr, Gulfport, Mississippi |
| Authorized Official Name and Position | Holly Regan (PRESIDENT) |
| Authorized Official Contact | 2283345233 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Serenity Coast Counseling Llc 12320 Ashley Dr Suite D Gulfport MS 39503-2550 Ph: (228) 334-5233 | Serenity Coast Counseling Llc 12320 Ashley Dr Suite D Gulfport MS 39503-2550 Ph: (228) 334-5233 |
| NPI Number | 1437691060 |
|---|---|
| Provider Enumeration Date | 11/14/2016 |
| Last Update Date | 11/14/2016 |
| Medicare PECOS PAC ID | 3072895457 |
|---|---|
| Medicare Enrollment ID | O20170119001020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437691060 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | C7870 (Mississippi) | Primary |
| Provider Name | Holly M Regan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962895664 PECOS PAC ID: 0143502526 Enrollment ID: I20170119001159 |
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