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General NPI Number Information
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NPI Number | 1316357726
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Entity Type | Organization
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Legal Business Name | FRESH START THERAPY SERVICES, LLC
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Dates
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Enumeration Date | 05/07/2014
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Last Update Date | 07/10/2014
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Provider Practice Location Address
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Address Line | 1417 N SEMORAN BLVD STE 201
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City | ORLANDO
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State | FL
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Zip | 32807-3555
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Country | US
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Telephone | 407-099-5164
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Fax |
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Provider Business Mailing Address
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Address Line | 650 N ALAFAYA TRL STE 101 # 782409
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City | ORLANDO
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State | FL
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Zip | 32878-7501
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Country | US
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Telephone | 407-900-5164
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LISA SPINDLE
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Credential | LCSW
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Telephone | 407-900-5164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | SW11509
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License Number State | FL
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