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General NPI Number Information
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NPI Number | 1700516424
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Entity Type | Organization
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Legal Business Name | FRESH AIR THERAPY, INC.
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Dates
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Enumeration Date | 06/15/2022
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Last Update Date | 06/15/2022
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Provider Practice Location Address
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Address Line | 1801 BALDWIN FARMS DR
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City | MARIETTA
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State | GA
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Zip | 30068-1555
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Country | US
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Telephone | 404-403-1545
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Fax |
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Provider Business Mailing Address
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Address Line | 1801 BALDWIN FARMS DR
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City | MARIETTA
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State | GA
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Zip | 30068-1555
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Country | US
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Telephone | 404-403-1545
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | EDWIN WALLACE ROBERTS
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Credential |
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Telephone | 404-403-1545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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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 | 103TF0000X
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Taxonomy Name | Family Psychologist
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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 | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #7
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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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Taxonomy #8
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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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