Provider Demographics
NPI:1396999199
Name:AWAKENING DORMANT MINDS LLC
Entity type:Organization
Organization Name:AWAKENING DORMANT MINDS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TOBY
Authorized Official - Middle Name:CHALONE
Authorized Official - Last Name:BRANDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-520-0125
Mailing Address - Street 1:1721 SAINT PHILIP ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70116-2116
Mailing Address - Country:US
Mailing Address - Phone:504-520-0125
Mailing Address - Fax:713-490-2683
Practice Address - Street 1:900 N VILLERE ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70116-2953
Practice Address - Country:US
Practice Address - Phone:504-520-0125
Practice Address - Fax:713-490-2683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health