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General NPI Number Information
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NPI Number | 1114253218
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Entity Type | Organization
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Legal Business Name | FRESH START COUNSELING
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Dates
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Enumeration Date | 10/23/2009
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Last Update Date | 10/23/2009
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Provider Practice Location Address
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Address Line | 1552 W LINCOLNWAY
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City | VALPARAISO
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State | IN
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Zip | 46385-0300
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Country | US
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Telephone | 219-548-9400
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Fax | 219-548-9444
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Provider Business Mailing Address
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Address Line | 1552 W LINCOLNWAY
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City | VALPARAISO
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State | IN
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Zip | 46385-0300
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Country | US
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Telephone | 219-548-9400
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Fax | 219-548-9444
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. VEROINCA RAMOS-CLARK
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Credential | MAC
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Telephone | 219-548-9400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1194-0-ASO
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1194-0-ASO
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License Number State | IN
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