Organization
AWAKEN BY WELLNESS LLC
Active
Other names
Aga Young
Organization subpart
No
Provider details
NPI number
Authorized official
AGA DANEEN YOUNG LIFESTYLE/WELLNESS (PRACTITIONER)
(228) 213-7972
Entity
Organization
Contact information
Practice address
606 NORTH UTICA STREET, TERRY, MS 39170
(228) 213-7972
Mailing address
606 NORTH UTICA STREET, TERRY, MS 39170
(228) 213-7972
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
—
—
251B00000X
Case Management Agency
—
—
251T00000X
PACE Provider Organization
—
—
261QC1500X
Community Health Clinic/Center
Primary
—
—
305R00000X
Preferred Provider Organization
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790491355
—
MS
Enumeration date
12/09/2024
Last updated
12/09/2024
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