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General NPI Number Information
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NPI Number | 1356985303
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Entity Type | Organization
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Legal Business Name | A BREATH OF FRESH AIR COUNSELING LLC
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Dates
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Enumeration Date | 11/02/2019
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Last Update Date | 08/17/2021
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Provider Practice Location Address
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Address Line | 55 ATLANTA ST SE
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City | MARIETTA
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State | GA
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Zip | 30060-1977
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Country | US
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Telephone | 470-238-9475
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Fax | 470-533-1545
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Provider Business Mailing Address
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Address Line | PO BOX 158
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City | MARIETTA
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State | GA
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Zip | 30061-0158
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Country | US
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Telephone | 773-263-6533
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Fax | 470-533-1545
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | MS. TANESHA DANIELLE WALKER
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Credential | M.ED, LPC
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Telephone | 470-238-9475
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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