=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114718939
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AWAKENLY THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2025
-----------------------------------------------------
Last Update Date | 05/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 W MONTGOMERY AVE APT 205
-----------------------------------------------------
City | ARDMORE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-878-9934
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4607 LIBRARY RD STE 220
-----------------------------------------------------
City | BETHEL PARK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15102-6909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-878-9934
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MRS. ALLISON NORMAN
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 347-878-9934
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------