Provider Demographics
NPI:1437470234
Name:AWAKENINGS COUNSELING CENTER, LLC
Entity type:Organization
Organization Name:AWAKENINGS COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHOJI
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:BOLDT
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:847-347-0688
Mailing Address - Street 1:111 LIONS DR
Mailing Address - Street 2:SUITE 221
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-3182
Mailing Address - Country:US
Mailing Address - Phone:847-347-0688
Mailing Address - Fax:847-381-1599
Practice Address - Street 1:111 LIONS DR
Practice Address - Street 2:SUITE 221
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-3182
Practice Address - Country:US
Practice Address - Phone:847-347-0688
Practice Address - Fax:847-381-1599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.004697101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1245426758OtherNPI TYPE 1