Provider Demographics
NPI:1134955198
Name:AWAKEN WELLNESS WITHIN
Entity type:Organization
Organization Name:AWAKEN WELLNESS WITHIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ALCIUS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:862-754-2723
Mailing Address - Street 1:46 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:ROSELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07068-1256
Mailing Address - Country:US
Mailing Address - Phone:862-754-2723
Mailing Address - Fax:
Practice Address - Street 1:1425 POMPTON AVE STE 1-3
Practice Address - Street 2:
Practice Address - City:CEDAR GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07009-1043
Practice Address - Country:US
Practice Address - Phone:909-220-9743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-09
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health