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General NPI Number Information
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NPI Number | 1386449163
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Entity Type | Organization
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Legal Business Name | AWAKENING MOUNTAINS LCSW PLLC
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Dates
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Enumeration Date | 02/17/2025
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 2364 STATE ROUTE 374
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City | ELLENBURG DEPOT
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State | NY
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Zip | 12935-3312
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Country | US
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Telephone | 315-276-6257
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Fax |
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Provider Business Mailing Address
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Address Line | 2364 STATE ROUTE 374
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City | ELLENBURG DEPOT
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State | NY
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Zip | 12935-3312
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Country | US
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Telephone | 315-276-6257
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ALYSSA LYNN PULLMAIN-DROLLETTE
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Credential | LCSW-R
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Telephone | 315-276-6257
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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