Provider Demographics
NPI:1598465528
Name:AWAKENINGS THERAPY GROUP
Entity type:Organization
Organization Name:AWAKENINGS THERAPY GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LPC/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TANEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDICK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:313-838-8716
Mailing Address - Street 1:16729 FERGUSON ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-3444
Mailing Address - Country:US
Mailing Address - Phone:313-838-8716
Mailing Address - Fax:
Practice Address - Street 1:8514 W MCNICHOLS RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-2570
Practice Address - Country:US
Practice Address - Phone:313-838-8716
Practice Address - Fax:313-838-8716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-08
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty