Provider Demographics
NPI:1326874298
Name:AWAKENING YOUR LIFE, LLC
Entity type:Organization
Organization Name:AWAKENING YOUR LIFE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LPC
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:MCKENNY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-968-5196
Mailing Address - Street 1:961 ROBERTS BRANCH PKWY - SUITE 106
Mailing Address - Street 2:PMB# 221
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203
Mailing Address - Country:US
Mailing Address - Phone:803-968-5196
Mailing Address - Fax:
Practice Address - Street 1:101 RICE BENT WAY STE 11
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-6850
Practice Address - Country:US
Practice Address - Phone:803-807-2795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty