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General NPI Number Information
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NPI Number | 1346080264
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Entity Type | Organization
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Legal Business Name | AWAKENING COUNSELING & CONSULTING, LLC
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Dates
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Enumeration Date | 05/29/2024
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Last Update Date | 05/29/2024
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Provider Practice Location Address
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Address Line | 30 S 15TH ST STE 1550 PMB 920751
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City | PHILADELPHIA
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State | PA
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Zip | 19102
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Country | US
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Telephone | 724-804-8591
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Fax |
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Provider Business Mailing Address
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Address Line | 30 S 15TH ST STE 1550 PMB 920751
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City | PHILADELPHIA
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State | PA
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Zip | 19102
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Country | US
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Telephone | 724-804-8591
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATELYN IRENE JAKUBOVIC
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Credential | MA, LPC
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Telephone | 724-771-5810
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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 |
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License Number State |
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