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General NPI Number Information
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NPI Number | 1215813936
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Entity Type | Organization
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Legal Business Name | STARTKINETIK, LLC
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Dates
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Enumeration Date | 08/15/2025
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Last Update Date | 08/15/2025
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Provider Practice Location Address
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Address Line | 3520 PIEDMONT RD NE STE 350
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City | ATLANTA
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State | GA
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Zip | 30305-1582
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Country | US
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Telephone | 404-348-8315
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Fax |
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Provider Business Mailing Address
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Address Line | 3520 PIEDMONT RD NE STE 350
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City | ATLANTA
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State | GA
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Zip | 30305-1582
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Country | US
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Telephone | 404-348-8315
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARY LISA HUBER
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Credential | MD
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Telephone | 404-348-8315
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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