Provider Demographics
NPI:1568729416
Name:AWAKENINGS COUNSELING PROGRAM
Entity Type:Organization
Organization Name:AWAKENINGS COUNSELING PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HERMAN
Authorized Official - Middle Name:WALLACE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-484-2700
Mailing Address - Street 1:3635 OLD COURT RD STE 405
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-3908
Mailing Address - Country:US
Mailing Address - Phone:410-484-2700
Mailing Address - Fax:410-484-1949
Practice Address - Street 1:2 W AYLESBURY RD
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-4101
Practice Address - Country:US
Practice Address - Phone:410-484-2700
Practice Address - Fax:410-484-1949
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GLASS HEALTH PROGRAMS INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-17
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD904299261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone