NPIMap

Organization Active NPI

Serenity Counseling & Resource Center, Inc

  • Professional Counselor
  • Winston Salem, NC
National Provider Identifier
1669650503
Registry record updated Mar 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
6709 Issued in NC
Legal business name
SERENITY COUNSELING & RESOURCE CENTER, INC
Practice address
1510 Martin St Ste 103
Winston Salem, NC 27103-4931
Phone
(336) 287-7929
Fax
(336) 287-7929
NPI assigned
Feb 1, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2020

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

Authorized official

Name
Dr. Kimberly M. CuthrellNPI 1639367220
Title
Presidentchief Executive Director
Phone
(336) 287-7929

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X 6709 NC Primary

Addresses

Primary practice location

1510 Martin St Ste 103
Winston Salem, NC 27103-4931

Mailing address

1510 Martin St Ste 103
Winston Salem, NC 27103-4931
Phone (336) 287-7929

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL kimberly.cuthrell@serenitycounselingrc.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111214000803 NC Part B Supplier - Clinic/Group Practice 2668647900 Receives reassigned benefits from 1 practitioner
Practice locations: Winston Salem, NC

National Provider Directory

National Provider Directory
Tax ID family
Serenity Counseling Resource Center5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 3

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": "1201824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584921600000",
    "number": "1669650503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1510 MARTIN ST STE 103",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271034931",
            "telephone_number": "336-287-7929",
            "fax_number": "336-287-7929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1510 MARTIN ST STE 103",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271034931",
            "telephone_number": "336-287-7929",
            "fax_number": "336-287-7929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERENITY COUNSELING & RESOURCE CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-01",
        "last_updated": "2020-03-23",
        "certification_date": "2020-03-23",
        "status": "A",
        "authorized_official_last_name": "CUTHRELL",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "PRESIDENTCHIEF EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "336-287-7929",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "6709",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "kimberly.cuthrell@serenitycounselingrc.com",
            "affiliation": "N",
            "endpointDescription": "Business Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Behaivioral Health Services",
            "address_1": "1510 Martin St Ste 103",
            "city": "Winston Salem",
            "state": "NC",
            "country_code": "US",
            "postal_code": "271034931",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.