Provider Demographics
NPI:1033700703
Name:AWAKEN THE GREATNESS
Entity Type:Organization
Organization Name:AWAKEN THE GREATNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHERISE
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:424-219-0315
Mailing Address - Street 1:2007 S LAS PALMAS
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-6352
Mailing Address - Country:US
Mailing Address - Phone:424-219-0315
Mailing Address - Fax:
Practice Address - Street 1:1822 S 39TH ST UNIT 120
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3831
Practice Address - Country:US
Practice Address - Phone:424-219-0315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty