| Awake Intumind, Llc | |
|
37 Belmont Street 3rd Floor Brockton MA 02301 | |
| (617) 749-7484 | |
| (508) 510-3530 |
| Full Name | Awake Intumind, Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 37 Belmont Street 3rd Floor, Brockton, Massachusetts |
| Authorized Official Name and Position | Edna Laurent-tellus (CEO/FOUNDER) |
| Authorized Official Contact | 6179471860 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Awake Intumind, Llc 119 Christopher Road Brockton MA 02302 Ph: (617) 749-7484 | Awake Intumind, Llc 37 Belmont Street 3rd Floor Brockton MA 02301 Ph: (617) 749-7484 |
| NPI Number | 1801270731 |
|---|---|
| Provider Enumeration Date | 07/09/2015 |
| Last Update Date | 02/12/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801270731 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 1032073 (Massachusetts) | Primary |
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