Healthcare Provider Details

I. General information

NPI: 1619850690
Provider Name (Legal Business Name): AWAKEN HOLISTIC THERAPY - MARRIAGE AND FAMILY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1606 MAIN ST
NAPA CA
94559-1800
US

IV. Provider business mailing address

2310 MAIN ST
NAPA CA
94558-5027
US

V. Phone/Fax

Practice location:
  • Phone: 773-936-6339
  • Fax:
Mailing address:
  • Phone: 773-936-6339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE ANNE SEVESKA
Title or Position: OWNER
Credential: LMFT
Phone: 773-936-6339