Provider Demographics
NPI:1023833100
Name:AWARENESS AND THERAPEUTIC ATTACHMENT ASSOCIATES, LLC
Entity type:Organization
Organization Name:AWARENESS AND THERAPEUTIC ATTACHMENT ASSOCIATES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:B
Authorized Official - Last Name:DONOVAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPCMH
Authorized Official - Phone:302-530-9520
Mailing Address - Street 1:1053 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-8060
Mailing Address - Country:US
Mailing Address - Phone:302-530-9520
Mailing Address - Fax:
Practice Address - Street 1:614 BLACK GATES RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-2240
Practice Address - Country:US
Practice Address - Phone:302-530-9520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-22
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE250797368Medicaid