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General NPI Number Information
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NPI Number | 1952117533
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Entity Type | Organization
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Legal Business Name | AWAKEN BY WELLNESS LLC
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Dates
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Enumeration Date | 12/09/2024
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 606 NORTH UTICA STREET
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City | TERRY
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State | MS
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Zip | 39170
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Country | US
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Telephone | 228-213-7972
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Fax |
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Provider Business Mailing Address
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Address Line | 606 NORTH UTICA STREET
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City | TERRY
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State | MS
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Zip | 39170
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Country | US
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Telephone | 228-213-7972
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Fax |
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Authorized Official
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Title or Position | PRACTITIONER
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Name | AGA DANEEN YOUNG
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Credential | LIFESTYLE/WELLNESS
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Telephone | 228-213-7972
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251T00000X
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Taxonomy Name | PACE Provider Organization
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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