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General NPI Number Information
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NPI Number | 1700592599
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Entity Type | Organization
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Legal Business Name | AWAKENED MIND COUNSELING
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Dates
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Enumeration Date | 01/25/2023
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Last Update Date | 03/10/2023
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Provider Practice Location Address
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Address Line | 2360 W JEFFERSON AVE STE 102
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City | TRENTON
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State | MI
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Zip | 48183-2706
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Country | US
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Telephone | 734-365-6976
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Fax | 734-283-7287
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Provider Business Mailing Address
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Address Line | 2360 W JEFFERSON AVE STE 102
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City | TRENTON
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State | MI
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Zip | 48183-2706
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Country | US
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Telephone | 734-365-6976
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Fax | 734-283-7287
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Authorized Official
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Title or Position | OWNER
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Name | GENNY L LUPPINO
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Credential | LPC
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Telephone | 989-312-5845
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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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