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General NPI Number Information
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NPI Number | 1124719745
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Entity Type | Organization
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Legal Business Name | FRESH START COUNSELING AND TESTING SERVICES, LLC
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Dates
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Enumeration Date | 05/16/2023
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Last Update Date | 05/22/2023
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Provider Practice Location Address
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Address Line | 1862 SHYVILLE RD STE 124
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City | PIKETON
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State | OH
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Zip | 45661-9749
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Country | US
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Telephone | 740-646-5161
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Fax | 877-329-1375
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Provider Business Mailing Address
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Address Line | 1862 SHYVILLE RD STE 124
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City | PIKETON
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State | OH
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Zip | 45661-9749
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Country | US
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Telephone | 740-646-5161
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Fax | 877-329-1375
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | ERIN DUDUIT
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Credential | PHD
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Telephone | 740-646-5161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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