Provider Demographics
NPI:1356985303
Name:A BREATH OF FRESH AIR COUNSELING LLC
Entity type:Organization
Organization Name:A BREATH OF FRESH AIR COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TANESHA
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC
Authorized Official - Phone:470-238-9475
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30061-0158
Mailing Address - Country:US
Mailing Address - Phone:773-263-6533
Mailing Address - Fax:470-533-1545
Practice Address - Street 1:55 ATLANTA ST SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1977
Practice Address - Country:US
Practice Address - Phone:470-238-9475
Practice Address - Fax:470-533-1545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-02
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty