Organization
SERENITY COUNSELING SERVICES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GILDA G BROADWELL PHD (PSYCHOLOGIST)
(772) 692-8585
Entity
Organization
Contact information
Practice address
500 NW DIXIE HWY, SUITE 102, STUART, FL 34994
(772) 692-8585
(772) 692-5651
Mailing address
PO BOX 2474, STUART, FL 34995
(772) 692-8585
(772) 692-5651
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
PY5591
FL
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
1943AD620400
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15-43-AD-6204-00
C&F SUB ABUSE COUNSELING
FL
Enumeration date
01/26/2007
Last updated
10/23/2012
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