Provider Demographics
NPI:1619285046
Name:EQUINE AWAKENINGS, INC.
Entity Type:Organization
Organization Name:EQUINE AWAKENINGS, INC.
Other - Org Name:CENTER FOR AWAKENINGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHALL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:561-598-9118
Mailing Address - Street 1:1515 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93402-1611
Mailing Address - Country:US
Mailing Address - Phone:561-598-9118
Mailing Address - Fax:
Practice Address - Street 1:6613B BAY LAUREL PL
Practice Address - Street 2:
Practice Address - City:AVILA BEACH
Practice Address - State:CA
Practice Address - Zip Code:93424-3504
Practice Address - Country:US
Practice Address - Phone:561-598-9118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-20
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW96451041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty