Provider Demographics
NPI:1609765718
Name:AWAKENED POTENTIAL THERAPY
Entity type:Organization
Organization Name:AWAKENED POTENTIAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ FOUNDRESS
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEKHNIK
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:347-495-7163
Mailing Address - Street 1:103 PARTRIDGE RUN
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-8957
Mailing Address - Country:US
Mailing Address - Phone:347-495-7163
Mailing Address - Fax:
Practice Address - Street 1:103 PARTRIDGE RUN
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-8957
Practice Address - Country:US
Practice Address - Phone:347-495-7163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty