Healthcare Provider Details

I. General information

NPI: 1215813936
Provider Name (Legal Business Name): STARTKINETIK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 PIEDMONT RD NE STE 350
ATLANTA GA
30305-1582
US

IV. Provider business mailing address

3520 PIEDMONT RD NE STE 350
ATLANTA GA
30305-1582
US

V. Phone/Fax

Practice location:
  • Phone: 404-348-8315
  • Fax:
Mailing address:
  • Phone: 404-348-8315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARY LISA HUBER
Title or Position: OWNER
Credential: MD
Phone: 404-348-8315