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General NPI Number Information
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NPI Number | 1730809732
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Entity Type | Organization
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Legal Business Name | FRESH START THERAPEUTIC SERVICES, LLC
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Dates
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Enumeration Date | 08/30/2022
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Last Update Date | 08/30/2022
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Provider Practice Location Address
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Address Line | 626 TOWNE CENTER DR STE 204
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City | JOPPA
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State | MD
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Zip | 21085-4451
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Country | US
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Telephone | 443-313-3241
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Fax |
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Provider Business Mailing Address
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Address Line | 626 TOWNE CENTER DR STE 204
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City | JOPPA
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State | MD
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Zip | 21085-4451
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL MANAGER
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Name | TEKORA NICHOLS
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Credential |
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Telephone | 240-370-9479
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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