| Serenity House Pch, Inc. | |
|
210 Garden Cir Hinesville GA 31313-4421 | |
| (912) 977-4663 | |
| (912) 369-6530 |
| Full Name | Serenity House Pch, Inc. |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 210 Garden Cir, Hinesville, Georgia |
| Authorized Official Name and Position | Deidre Cobb Tift (PRESIDENT) |
| Authorized Official Contact | 9129774643 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Serenity House Pch, Inc. 210 Garden Cir Hinesville GA 31313-4421 Ph: (912) 977-4663 | Serenity House Pch, Inc. 210 Garden Cir Hinesville GA 31313-4421 Ph: (912) 977-4663 |
| NPI Number | 1720396773 |
|---|---|
| Provider Enumeration Date | 09/23/2010 |
| Last Update Date | 09/30/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720396773 | NPI | - | NPPES |
| 047158461A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 080640 (Michigan) | Secondary |
| 106H00000X | Marriage & Family Therapist | MSW002656 (Georgia) | Primary |
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