Provider Demographics
NPI:1457712218
Name:AWJW1 LLC
Entity Type:Organization
Organization Name:AWJW1 LLC
Other - Org Name:SOBRIETY SOLUTIONS PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF CLINCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUSHNER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:484-965-9524
Mailing Address - Street 1:1000 GERMANTOWN PIKE STE E1
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-2485
Mailing Address - Country:US
Mailing Address - Phone:484-965-9529
Mailing Address - Fax:
Practice Address - Street 1:1000 GERMANTOWN PIKE STE E1
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-2485
Practice Address - Country:US
Practice Address - Phone:484-965-9529
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-08
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0850X, 261QR0405X
PAPC007754261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health