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General NPI Number Information
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NPI Number | 1194129239
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Entity Type | Organization
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Legal Business Name | AWAKEN THE POWER THERAPY, LLC
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Dates
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Enumeration Date | 10/17/2014
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Last Update Date | 12/23/2019
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Provider Practice Location Address
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Address Line | 57 PLAINS RD UNIT 1C
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City | MILFORD
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State | CT
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Zip | 06461-2573
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Country | US
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Telephone | 203-693-1050
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Fax | 203-306-3388
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Provider Business Mailing Address
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Address Line | 57 PLAINS RD UNIT 1C
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City | MILFORD
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State | CT
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Zip | 06461-2573
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Country | US
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Telephone | 203-693-1050
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Fax | 203-306-3386
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Authorized Official
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Title or Position | DIRECTOR
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Name | MONIQUE E WEST
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Credential |
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Telephone | 203-693-1050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2524
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2867
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 002950
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1813
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License Number State | CT
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 8711
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License Number State | CT
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