Healthcare Provider Details

I. General information

NPI: 1124492665
Provider Name (Legal Business Name): AWAKEN THE SPIRIT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2015
Last Update Date: 09/02/2025
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 NEWBURG AVE STE 100
CATONSVILLE MD
21228-5168
US

IV. Provider business mailing address

9 NEWBURG AVE STE 100
CATONSVILLE MD
21228-5168
US

V. Phone/Fax

Practice location:
  • Phone: 410-747-9743
  • Fax: 410-747-9910
Mailing address:
  • Phone: 410-747-9743
  • Fax: 410-747-9910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU01507
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number09177
License Number StateMD

VIII. Authorized Official

Name: CHERYL A DEPETRO
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 410-747-9743