Provider Demographics
NPI:1184975443
Name:CONSCIOUS AWAKENING COUNSELING AND CONSULTING PLLC
Entity type:Organization
Organization Name:CONSCIOUS AWAKENING COUNSELING AND CONSULTING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARUKA
Authorized Official - Middle Name:J
Authorized Official - Last Name:RIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:336-456-3576
Mailing Address - Street 1:612 WHITTIER DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-1121
Mailing Address - Country:US
Mailing Address - Phone:336-456-3576
Mailing Address - Fax:
Practice Address - Street 1:612 PASTEUR DR
Practice Address - Street 2:209
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1149
Practice Address - Country:US
Practice Address - Phone:336-456-3576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0076071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty