Serendipity Counseling & Consulting Agency

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

Last updated

Jun 17, 2019By the provider in NPPES

Organization subpart

No

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

Specialties & licenses 4

Addresses

Electronic endpoints 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Crystal Joy Micken, LPC, CRC

  • Professional Counselor
  • Bainbridge, GA
  • NPI 1770059313
  NPD (past) Authorized official

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": []
}

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• Professional Counselor in Bainbridge, GA
• Providers in Bainbridge, GA by specialty
• Professional Counselor in Georgia

• 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.