Provider Demographics
NPI:1326318528
Name:AWE
Entity Type:Organization
Organization Name:AWE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WESTON
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:209-668-6118
Mailing Address - Street 1:588 BLOSSOM HILL RD STE A
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-3211
Mailing Address - Country:US
Mailing Address - Phone:408-607-7240
Mailing Address - Fax:408-629-5709
Practice Address - Street 1:588 BLOSSOM HILL RD STE A
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-3211
Practice Address - Country:US
Practice Address - Phone:408-607-7240
Practice Address - Fax:408-629-5709
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASPIRANET
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31644251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health