Organization
AWAKE INTUMIND, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. EDNA LAURENT-TELLUS LICSW (CEO/FOUNDER)
(617) 947-1860
Entity
Organization
Contact information
Practice address
37 BELMONT STREET 3RD FLOOR, BROCKTON, MA 02301
(617) 749-7484
(508) 510-3530
Mailing address
119 CHRISTOPHER ROAD, BROCKTON, MA 02302
(617) 749-7484
(508) 510-3530
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
1032073
MA
Other
Enumeration date
07/09/2015
Last updated
02/12/2016
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