Provider Demographics
NPI:1114583770
Name:PANDORAS AWAKENING
Entity Type:Organization
Organization Name:PANDORAS AWAKENING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:D
Authorized Official - Last Name:BURWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, MPA, CST
Authorized Official - Phone:615-375-6896
Mailing Address - Street 1:223 MADISON ST STE 102
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-3660
Mailing Address - Country:US
Mailing Address - Phone:615-375-6896
Mailing Address - Fax:
Practice Address - Street 1:223 MADISON ST STE 102
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-3660
Practice Address - Country:US
Practice Address - Phone:615-375-6896
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-18
Last Update Date:2019-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Multi-Specialty