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General NPI Number Information
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NPI Number | 1184966061
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Entity Type | Organization
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Legal Business Name | FRESH START FOR THE MIND, LLC
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Dates
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Enumeration Date | 03/19/2013
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Last Update Date | 03/19/2013
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Provider Practice Location Address
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Address Line | 4080 MCGINNIS FERRY RD SUITE 204
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City | ALPHARETTA
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State | GA
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Zip | 30005-3948
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Country | US
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Telephone | 404-808-1161
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Fax | 404-464-0784
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Provider Business Mailing Address
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Address Line | 2630 MAPLE LEAF TER
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City | CUMMING
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State | GA
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Zip | 30041-6617
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Country | US
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Telephone | 404-464-0784
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. BROOKE A JONES
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Credential | PSYD
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Telephone | 404-808-1161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY003516
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License Number State | GA
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