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General NPI Number Information
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NPI Number | 1265059067
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Entity Type | Organization
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Legal Business Name | FRESH START FAMILY THERAPY SERVICES
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Dates
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Enumeration Date | 06/29/2020
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Last Update Date | 06/29/2020
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Provider Practice Location Address
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Address Line | 600 SOMERDALE RD STE 101
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City | VOORHEES
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State | NJ
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Zip | 08043-1858
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Country | US
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Telephone | 856-220-7035
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Fax | 856-595-9377
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Provider Business Mailing Address
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Address Line | 38 WALNUT AVE
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City | LINDENWOLD
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State | NJ
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Zip | 08021-1635
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Country | US
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Telephone | 856-220-7035
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Fax | 856-595-9377
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Authorized Official
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Title or Position | OWNER
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Name | MS. BRIDGET JUANIQUE LARK
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Credential | LMFT
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Telephone | 856-220-7035
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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 |
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License Number State |
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