| Serenity Counseling Services Pa | |
|
500 Nw Dixie Hwy Suite 102 Stuart FL 34994 | |
| (772) 692-8585 | |
| (772) 692-5651 |
| Full Name | Serenity Counseling Services Pa |
|---|---|
| Speciality | Clinic/Center |
| Location | 500 Nw Dixie Hwy, Stuart, Florida |
| Authorized Official Name and Position | Gilda G Broadwell (PSYCHOLOGIST) |
| Authorized Official Contact | 7726928585 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Serenity Counseling Services Pa Po Box 2474 Stuart FL 34995 Ph: (772) 692-8585 | Serenity Counseling Services Pa 500 Nw Dixie Hwy Suite 102 Stuart FL 34994 Ph: (772) 692-8585 |
| NPI Number | 1275689812 |
|---|---|
| Provider Enumeration Date | 01/26/2007 |
| Last Update Date | 10/23/2012 |
| Medicare PECOS PAC ID | 7618948183 |
|---|---|
| Medicare Enrollment ID | O20040805001562 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275689812 | NPI | - | NPPES |
| 15-43-AD-6204-00 | Other | FL | C&F SUB ABUSE COUNSELING |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | PY5591 (Florida) | Secondary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | 1943AD620400 (Florida) | Primary |
| Provider Name | Gilda Gene Broadwell |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1942421995 PECOS PAC ID: 4880665363 Enrollment ID: I20040806000323 |
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