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Organization
SERENITY LANE
Active
Organization
SERENITY LANE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANTHONY WILLIAM HAYNES BS CADCII (PROGRAM COORDINATOR)
(541) 673-3504
Entity
Organization
Contact information
Practice address
2575 NW KLINE ST, ROSEBURG, OR 97471-8827
(541) 673-3504
(541) 673-4724
Mailing address
2575 NW KLINE ST, ROSEBURG, OR 97471-8827
(541) 673-3504
(541) 673-4724
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
13-12-59
OR
Other
Enumeration date
09/07/2016
Last updated
09/07/2016
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