Provider Demographics
NPI:1669278735
Name:AWAKENING GRACE THERAPY LLC
Entity type:Organization
Organization Name:AWAKENING GRACE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:JO
Authorized Official - Last Name:REI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:318-540-8576
Mailing Address - Street 1:539 DOGWOOD SOUTH LN
Mailing Address - Street 2:
Mailing Address - City:HAUGHTON
Mailing Address - State:LA
Mailing Address - Zip Code:71037-8554
Mailing Address - Country:US
Mailing Address - Phone:318-540-8576
Mailing Address - Fax:
Practice Address - Street 1:539 DOGWOOD SOUTH LN
Practice Address - Street 2:
Practice Address - City:HAUGHTON
Practice Address - State:LA
Practice Address - Zip Code:71037-8554
Practice Address - Country:US
Practice Address - Phone:318-540-8576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health