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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