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General NPI Number Information
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NPI Number | 1093029019
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Entity Type | Organization
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Legal Business Name | FRESH START COUNSELING SERVICES
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Dates
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Enumeration Date | 08/02/2010
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Last Update Date | 08/02/2010
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Provider Practice Location Address
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Address Line | 326 MYRTLE CROSSING DR SUITE 200
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City | STATESBORO
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State | GA
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Zip | 30458-4429
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Country | US
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Telephone | 912-489-7590
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Fax | 912-489-3877
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Provider Business Mailing Address
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Address Line | 326 MYRTLE CROSSING DR SUITE 200
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City | STATESBORO
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State | GA
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Zip | 30458-4429
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Country | US
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Telephone | 912-489-7590
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Fax | 912-489-3877
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Authorized Official
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Title or Position | PARTNER
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Name | CYNTHIA LEE
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Credential | LPC
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Telephone | 912-486-7590
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT000892
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC005560
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License Number State | GA
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