Provider Demographics
NPI:1548969504
Name:AWAKENING
Entity type:Organization
Organization Name:AWAKENING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INDIVIDUAL CONTRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-572-3420
Mailing Address - Street 1:17 PARADISE RD # 1057
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-4229
Mailing Address - Country:US
Mailing Address - Phone:978-219-6749
Mailing Address - Fax:
Practice Address - Street 1:17 PARADISE RD # 1057
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-4229
Practice Address - Country:US
Practice Address - Phone:978-219-6749
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty