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Organization
SERENITY SHIELD INC.
Active
Organization
SERENITY SHIELD INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DERRICK JAMES JOHNSON PSY.D (VICE PRESIDENT)
(708) 657-5043
Entity
Organization
Contact information
Practice address
2 E ERIE ST APT 2712, CHICAGO, IL 60611-6211
(708) 657-5043
(312) 643-1187
Mailing address
2 E ERIE ST, CHICAGO, IL 60611-2724
(708) 657-5043
(312) 643-1187
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Enumeration date
02/21/2021
Last updated
02/09/2022
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