Provider Demographics
NPI:1952883183
Name:AWAKENING CHANGE COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:AWAKENING CHANGE COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:MINIQUE
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, LPC, LCADC, ACS
Authorized Official - Phone:609-560-7395
Mailing Address - Street 1:1010 HADDONFIELD BERLIN RD STE 403
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-3514
Mailing Address - Country:US
Mailing Address - Phone:856-873-9069
Mailing Address - Fax:856-896-0726
Practice Address - Street 1:1010 HADDONFIELD BERLIN RD STE 403
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-3514
Practice Address - Country:US
Practice Address - Phone:856-873-9069
Practice Address - Fax:856-896-0726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-04
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00198300101YA0400X
NJ37PC00636000101YP2500X
PAPC009892101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty