Provider Demographics
NPI:1750973467
Name:AWAKENING LLC
Entity type:Organization
Organization Name:AWAKENING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:O
Authorized Official - Last Name:ESQUIVEL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:617-455-8399
Mailing Address - Street 1:2021 L ST NW STE 101-279
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-4909
Mailing Address - Country:US
Mailing Address - Phone:617-455-8399
Mailing Address - Fax:
Practice Address - Street 1:1638 R ST NW STE 300
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-6451
Practice Address - Country:US
Practice Address - Phone:617-455-8399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty