Provider Demographics
NPI:1093029019
Name:FRESH START COUNSELING SERVICES
Entity Type:Organization
Organization Name:FRESH START COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:912-486-7590
Mailing Address - Street 1:326 MYRTLE CROSSING DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-4429
Mailing Address - Country:US
Mailing Address - Phone:912-489-7590
Mailing Address - Fax:912-489-3877
Practice Address - Street 1:326 MYRTLE CROSSING DR
Practice Address - Street 2:SUITE 200
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-4429
Practice Address - Country:US
Practice Address - Phone:912-489-7590
Practice Address - Fax:912-489-3877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005560101YP2500X
GAMFT000892106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty