Provider Demographics
NPI:1164211553
Name:AWAKENING OF THE SOUL PSYCHOTHERAPY SERVICES, LLC
Entity type:Organization
Organization Name:AWAKENING OF THE SOUL PSYCHOTHERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WILMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VEGA- MATOS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:787-203-1535
Mailing Address - Street 1:1005 LOUISA AVE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-2931
Mailing Address - Country:US
Mailing Address - Phone:787-203-1535
Mailing Address - Fax:
Practice Address - Street 1:1005 LOUISA AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-2931
Practice Address - Country:US
Practice Address - Phone:787-203-1535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty