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Organization
DIVINE INTERACTIONS EQUINE FACILITATED WELLNESS, LLC
Active
Organization
DIVINE INTERACTIONS EQUINE FACILITATED WELLNESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNA AUGHENBAUGH MA, NCC, LPC, CCTP (SOLE MEMBER)
(724) 858-7204
Entity
Organization
Contact information
Practice address
1719 QUARRY LANE, APOLLO, PA 15613
(724) 858-7204
Mailing address
554 PLEASANT VIEW DR, APOLLO, PA 15613-9225
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
PC009805
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1891206850
LICENSED PROFESSIONAL COUNSELOR
PA
Enumeration date
04/30/2018
Last updated
04/30/2018
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