| Awakening Mountains Lcsw Pllc | |
|
2364 State Route 374 Ellenburg Depot NY 12935-3312 | |
| (315) 276-6257 | |
| Not Available |
| Full Name | Awakening Mountains Lcsw Pllc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 2364 State Route 374, Ellenburg Depot, New York |
| Authorized Official Name and Position | Alyssa Lynn Pullmain-drollette (CEO) |
| Authorized Official Contact | 3152766257 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Awakening Mountains Lcsw Pllc 2364 State Route 374 Ellenburg Depot NY 12935-3312 Ph: (315) 276-6257 | Awakening Mountains Lcsw Pllc 2364 State Route 374 Ellenburg Depot NY 12935-3312 Ph: (315) 276-6257 |
| NPI Number | 1386449163 |
|---|---|
| Provider Enumeration Date | 02/17/2025 |
| Last Update Date | 02/17/2025 |
| Certification Date | 02/17/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386449163 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |