| Awaken Licensed Applied Behavioral Analysis Services Pllc | |
|
8480 Baltimore National Pike Ste 3210 #126 Ellicott City MD 21043 | |
| (914) 713-7974 | |
| Not Available |
| Full Name | Awaken Licensed Applied Behavioral Analysis Services Pllc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 8480 Baltimore National Pike Ste 3210 #126, Ellicott City, Maryland |
| Authorized Official Name and Position | Petagaye S. Townsend (CHIEF OPERATING OFFICER) |
| Authorized Official Contact | 9143638313 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Awaken Licensed Applied Behavioral Analysis Services Pllc 8480 Baltimore National Pike Ste 3210 #126 Ellicott City MD 21043 Ph: (914) 713-7974 | Awaken Licensed Applied Behavioral Analysis Services Pllc 8480 Baltimore National Pike Ste 3210 #126 Ellicott City MD 21043 Ph: (914) 713-7974 |
| NPI Number | 1174097547 |
|---|---|
| Provider Enumeration Date | 01/18/2019 |
| Last Update Date | 04/30/2021 |
| Certification Date | 04/30/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174097547 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
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