Healthcare Provider Details

I. General information

NPI: 1184036824
Provider Name (Legal Business Name): AWAKENING COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2014
Last Update Date: 05/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1724 VILLAGE WAY STE A
ORANGE PARK FL
32073-5225
US

IV. Provider business mailing address

1724 VILLAGE WAY STE A
ORANGE PARK FL
32073-5225
US

V. Phone/Fax

Practice location:
  • Phone: 904-269-0886
  • Fax: 904-269-0499
Mailing address:
  • Phone: 904-269-0886
  • Fax: 904-269-0499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH10580
License Number StateFL

VIII. Authorized Official

Name: DISHAUN DAVIS
Title or Position: OWNER
Credential: LMHC
Phone: 904-444-8260