MEDICARE: A BREATH OF FRESH AIR COUNSELING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1356985303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A BREATH OF FRESH AIR COUNSELING LLC

Provider Business Mailing Address
First Line	:	PO BOX 158
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30061-0158
Country	:	US
Telephone Number	:	773-263-6533
Fax Number	:	470-533-1545

Provider Business Practice Location Address
First Line	:	55 ATLANTA ST SE
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30060-1977
Country	:	US
Telephone Number	:	470-238-9475
Fax Number	:	470-533-1545

Authorized Official
Title or Position	:	LICENSED PROFESSIONAL COUNSELOR
Name	:	MS. TANESHA DANIELLE WALKER
Credential	:	M.ED, LPC
Telephone Number	:	470-238-9475

Provider Enumeration Date	:	11/02/2019
Last Update Date	:	08/17/2021

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