=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659084630
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MENTAL AWAKENING COUNSELING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2023
-----------------------------------------------------
Last Update Date | 06/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5 MIRACLE STRIP LOOP STE 15
-----------------------------------------------------
City | PANAMA CITY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32407-8410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-235-8495
-----------------------------------------------------
Fax | 850-235-8495
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5 MIRACLE STRIP LOOP STE 15
-----------------------------------------------------
City | PANAMA CITY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32407-8410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-235-8495
-----------------------------------------------------
Fax | 850-235-8495
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER AND PROVIDER
-----------------------------------------------------
Name | ROBIN LYNN JORDAN
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 502-689-1613
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------