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General NPI Number Information
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NPI Number | 1801337100
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Entity Type | Organization
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Legal Business Name | INNER AWAKENING COUNSELING & CONSULTATION, PLLC
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Dates
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Enumeration Date | 03/20/2017
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Last Update Date | 03/20/2017
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Provider Practice Location Address
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Address Line | 115 AIKENS CTR STE 14
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City | MARTINSBURG
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State | WV
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Zip | 25404-6210
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Country | US
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Telephone | 304-820-9365
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Fax | 304-820-9365
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Provider Business Mailing Address
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Address Line | 115 AIKENS CTR STE 14
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City | MARTINSBURG
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State | WV
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Zip | 25404-6210
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Country | US
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Telephone | 304-820-9365
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Fax | 304-820-9365
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Authorized Official
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Title or Position | OWNER
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Name | DANIEL A. SPEIS
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Credential | LICSW
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Telephone | 304-820-9365
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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 | DP00942760
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License Number State | WV
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