Healthcare Provider Details

I. General information

NPI: 1922961507
Provider Name (Legal Business Name): AWAKENING CHRYSALIS COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 S HIGLEY RD STE 104
GILBERT AZ
85296-5045
US

IV. Provider business mailing address

1525 S HIGLEY RD STE 104
GILBERT AZ
85296-5045
US

V. Phone/Fax

Practice location:
  • Phone: 520-280-6272
  • Fax:
Mailing address:
  • Phone: 520-280-6272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: TAHONNA WOO
Title or Position: BHP/CLINICAL DIRECTOR
Credential: MA LAC MS LIAC
Phone: 520-280-6272