Provider Demographics
NPI:1275381550
Name:HOLISTIC AWAKENING L.L.C.
Entity Type:Organization
Organization Name:HOLISTIC AWAKENING L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH PROFESSIONAL
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:WHETSTONE
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:501-993-9023
Mailing Address - Street 1:20 LOU ELLEN DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-1502
Mailing Address - Country:US
Mailing Address - Phone:501-993-9023
Mailing Address - Fax:
Practice Address - Street 1:2821 KAVANAUGH BLVD STE 1B
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-3868
Practice Address - Country:US
Practice Address - Phone:501-993-9023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)