Provider Demographics
NPI:1386276467
Name:AWEH SUPPORT
Entity type:Organization
Organization Name:AWEH SUPPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANIM
Authorized Official - Middle Name:OLDNEY
Authorized Official - Last Name:AWEH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW LICSW
Authorized Official - Phone:617-319-6356
Mailing Address - Street 1:3498 BRYCEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-6264
Mailing Address - Country:US
Mailing Address - Phone:617-319-6356
Mailing Address - Fax:
Practice Address - Street 1:3498 BRYCEWOOD DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-6264
Practice Address - Country:US
Practice Address - Phone:617-319-6356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty