Provider Demographics
NPI:1518591858
Name:AWAKENINGS PSYCHIATRIC SERVICES, PC
Entity Type:Organization
Organization Name:AWAKENINGS PSYCHIATRIC SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGSTREET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-777-3039
Mailing Address - Street 1:1010 E NORTH ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-3166
Mailing Address - Country:US
Mailing Address - Phone:864-777-3039
Mailing Address - Fax:864-400-9714
Practice Address - Street 1:1010 E NORTH ST STE 1A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3166
Practice Address - Country:US
Practice Address - Phone:864-777-3039
Practice Address - Fax:864-400-9714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-25
Last Update Date:2020-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty