Organization
AWAKENINGS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MELODY KAY LORENZO CDP (ADMINISTRATOR)
(360) 423-2806
Entity
Organization
Contact information
Practice address
920 FIR ST, LONGVIEW, WA 98632-2525
(360) 423-2806
(360) 423-5128
Mailing address
920 FIR ST, LONGVIEW, WA 98632-2525
(360) 423-2806
(360) 423-5128
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
251S00000X
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
081193
STATE CERTIFICATION
WA
Enumeration date
05/03/2007
Last updated
08/22/2020
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