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General NPI Number Information
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NPI Number | 1770114084
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Entity Type | Organization
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Legal Business Name | START ANEW COUNSELING, LLC
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Dates
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Enumeration Date | 01/27/2020
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Last Update Date | 02/08/2020
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Provider Practice Location Address
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Address Line | 284 GERMAN OAK DR STE 103
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City | CORDOVA
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State | TN
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Zip | 38018-7276
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Country | US
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Telephone | 901-457-5685
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Fax |
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Provider Business Mailing Address
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Address Line | 1863 SPEYBURN CV
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City | CORDOVA
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State | TN
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Zip | 38016-1620
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Country | US
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Telephone | 901-907-6445
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LAKENYA HUMPHREY
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Credential | LCSW
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Telephone | 901-457-5685
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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