NPIMap

Organization Active NPI

Serendipity Counseling & Consulting Agency

  • Professional Counselor
  • Bainbridge, GA
National Provider Identifier
1487214052
Registry record updated Jun 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
SERENDIPITY COUNSELING & CONSULTING AGENCY
Practice address
1235 E Shotwell St
Bainbridge, GA 39819-4237
Phone
(229) 726-4714
NPI assigned
Jun 17, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Crystal Micken, LPC, CRCNPI 1770059313
Title
Owner/Operator
Phone
(229) 726-4714

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X Primary
Peer SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 175T00000X

Addresses

Primary practice location

1235 E Shotwell St
Bainbridge, GA 39819-4237

Mailing address

961 Hall St
Bainbridge, GA 39819-4645

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL SerendipityCCA

National Provider Directory

National Provider Directory

Locations

1235 E Shotwell St
Bainbridge, GA 39819
Phone (229) 726-4714

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1560729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560729600000",
    "number": "1487214052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "961 HALL ST",
            "city": "BAINBRIDGE",
            "state": "GA",
            "postal_code": "398194645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1235 E SHOTWELL ST",
            "city": "BAINBRIDGE",
            "state": "GA",
            "postal_code": "398194237",
            "telephone_number": "229-726-4714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERENDIPITY COUNSELING & CONSULTING AGENCY",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-17",
        "last_updated": "2019-06-17",
        "status": "A",
        "authorized_official_last_name": "MICKEN",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_title_or_position": "OWNER/OPERATOR",
        "authorized_official_telephone_number": "229-726-4714",
        "authorized_official_credential": "LPC, CRC"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "SerendipityCCA",
            "affiliation": "N",
            "address_1": "1235 E Shotwell St",
            "city": "Bainbridge",
            "state": "GA",
            "country_code": "US",
            "postal_code": "398194237",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bainbridge, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.