Healthcare Provider Details

I. General information

NPI: 1962188961
Provider Name (Legal Business Name): AWAKENING INSIGHT COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13654 BEECH DALY RD
TAYLOR MI
48180-4431
US

IV. Provider business mailing address

13654 BEECH DALY RD
TAYLOR MI
48180-4431
US

V. Phone/Fax

Practice location:
  • Phone: 734-678-1751
  • Fax:
Mailing address:
  • Phone: 734-678-1751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSHUA PAUL PANTER
Title or Position: OWNER / CLINICAL DIRECTOR
Credential: LMSW
Phone: 734-678-1751