Provider Demographics
NPI:1700592599
Name:AWAKENED MIND COUNSELING
Entity Type:Organization
Organization Name:AWAKENED MIND COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GENNY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LUPPINO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:989-312-5845
Mailing Address - Street 1:2360 W JEFFERSON AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-2706
Mailing Address - Country:US
Mailing Address - Phone:734-365-6976
Mailing Address - Fax:734-283-7287
Practice Address - Street 1:2360 W JEFFERSON AVE STE 102
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-2706
Practice Address - Country:US
Practice Address - Phone:734-365-6976
Practice Address - Fax:734-283-7287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-25
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health