Provider Demographics
NPI:1740977701
Name:AWAKENED MENTAL HEALTH PLLC
Entity type:Organization
Organization Name:AWAKENED MENTAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SOLA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-581-0818
Mailing Address - Street 1:101 CULVER LN
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06480-1324
Mailing Address - Country:US
Mailing Address - Phone:860-581-0818
Mailing Address - Fax:
Practice Address - Street 1:101 CULVER LN
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:CT
Practice Address - Zip Code:06480-1324
Practice Address - Country:US
Practice Address - Phone:860-581-0818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty