Provider Demographics
NPI:1710504642
Name:THE AWAKENING WELLNESS CLINIC, INC
Entity Type:Organization
Organization Name:THE AWAKENING WELLNESS CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:DENICE
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:CSAC
Authorized Official - Phone:910-340-3630
Mailing Address - Street 1:8 CARVER RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-7010
Mailing Address - Country:US
Mailing Address - Phone:910-340-3630
Mailing Address - Fax:910-597-1007
Practice Address - Street 1:8 CARVER RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-7010
Practice Address - Country:US
Practice Address - Phone:910-340-3630
Practice Address - Fax:910-597-1007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility