Provider Demographics
NPI:1841902343
Name:AWESOME LIFE SKILLS LLC
Entity type:Organization
Organization Name:AWESOME LIFE SKILLS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:D
Authorized Official - Last Name:PATCHET
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:267-972-0365
Mailing Address - Street 1:709 N 2ND STREET
Mailing Address - Street 2:SUITE 400 #1035
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-3108
Mailing Address - Country:US
Mailing Address - Phone:267-972-0365
Mailing Address - Fax:267-465-6360
Practice Address - Street 1:709 N 2ND STREET
Practice Address - Street 2:SUITE 400 #1035
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-3108
Practice Address - Country:US
Practice Address - Phone:267-972-0365
Practice Address - Fax:267-465-6360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-16
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)