Provider Demographics
NPI:1528219888
Name:FRESH START COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:FRESH START COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:SWAIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:727-571-3737
Mailing Address - Street 1:9600 KOGER BLVD N
Mailing Address - Street 2:#240
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2487
Mailing Address - Country:US
Mailing Address - Phone:727-571-3737
Mailing Address - Fax:727-556-0704
Practice Address - Street 1:9600 KOGER BLVD N
Practice Address - Street 2:#240
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-2487
Practice Address - Country:US
Practice Address - Phone:727-571-3737
Practice Address - Fax:727-556-0704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-06
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW7729261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health