Provider Demographics
NPI:1164177903
Name:CONSCIOUSNESS HOUSE
Entity Type:Organization
Organization Name:CONSCIOUSNESS HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:LAURIE
Authorized Official - Last Name:MADDOX
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:321-765-3102
Mailing Address - Street 1:121 E STEELE ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-3908
Mailing Address - Country:US
Mailing Address - Phone:407-462-0845
Mailing Address - Fax:
Practice Address - Street 1:121 E STEELE ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-3908
Practice Address - Country:US
Practice Address - Phone:321-765-3102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty