Provider Demographics
NPI:1790439651
Name:AWAKENLY LLC
Entity Type:Organization
Organization Name:AWAKENLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:D
Authorized Official - Last Name:NORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:573-268-9823
Mailing Address - Street 1:18 HEDGES AVE
Mailing Address - Street 2:
Mailing Address - City:CORNWALL ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12520-1208
Mailing Address - Country:US
Mailing Address - Phone:347-878-9934
Mailing Address - Fax:
Practice Address - Street 1:18 HEDGES AVE
Practice Address - Street 2:
Practice Address - City:CORNWALL ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12520-1208
Practice Address - Country:US
Practice Address - Phone:347-878-9934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY086181OtherLCSW
AZ18569OtherLCSW