Provider Demographics
NPI:1710670617
Name:DIVINE AWAKENING CENTER LLC
Entity Type:Organization
Organization Name:DIVINE AWAKENING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRANDEE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOWNES
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:385-319-1107
Mailing Address - Street 1:121 W 200 S
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-2327
Mailing Address - Country:US
Mailing Address - Phone:385-319-1107
Mailing Address - Fax:
Practice Address - Street 1:121 W 200 S
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-2327
Practice Address - Country:US
Practice Address - Phone:385-319-1107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-29
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty