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General NPI Number Information
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NPI Number | 1588056816
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Entity Type | Organization
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Legal Business Name | AWAKENING COUNSELING & COACHING INC.
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Dates
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Enumeration Date | 02/24/2015
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Last Update Date | 02/24/2015
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Provider Practice Location Address
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Address Line | 1724 VILLAGE WAY STE A
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City | ORANGE PARK
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State | FL
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Zip | 32073-5225
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Country | US
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Telephone | 904-269-0886
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Fax | 904-269-0499
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Provider Business Mailing Address
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Address Line | 10245 MAGNOLIA HILLS DR
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City | JACKSONVILLE
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State | FL
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Zip | 32210-4993
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Country | US
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Telephone | 904-444-8260
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Fax | 904-269-0499
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Authorized Official
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Title or Position | OWNER
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Name | DISHAUN DISU
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Credential | LMHC
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Telephone | 904-444-8260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH10580
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License Number State | FL
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