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General NPI Number Information
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NPI Number | 1669278735
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Entity Type | Organization
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Legal Business Name | AWAKENING GRACE THERAPY LLC
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Dates
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Enumeration Date | 02/20/2025
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Last Update Date | 09/17/2025
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Provider Practice Location Address
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Address Line | 2123 SHED RD STE 14
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City | BOSSIER CITY
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State | LA
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Zip | 71111-3617
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Country | US
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Telephone | 318-540-8576
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Fax | 318-383-0956
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Provider Business Mailing Address
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Address Line | 539 DOGWOOD SOUTH LN
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City | HAUGHTON
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State | LA
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Zip | 71037-8554
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Country | US
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Telephone | 318-540-8576
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | STEPHANIE JO REI
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Credential | LCSW
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Telephone | 318-540-8576
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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