Provider Demographics
NPI: | 1538530241 |
---|---|
Name: | FRESH START THERAPY AND WELLNESS LLC |
Entity type: | Organization |
Organization Name: | FRESH START THERAPY AND WELLNESS LLC |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | FOUNDER AND CHIEF EXECUTIVE OFFICER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JENNY |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | CURRIE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LPC AND LPCC |
Authorized Official - Phone: | 203-293-8554 |
Mailing Address - Street 1: | 7515 EAGLE TRACE DR |
Mailing Address - Street 2: | |
Mailing Address - City: | WESTERVILLE |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 43082-8491 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 203-293-8554 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 7515 EAGLE TRACE DR |
Practice Address - Street 2: | |
Practice Address - City: | WESTERVILLE |
Practice Address - State: | OH |
Practice Address - Zip Code: | 43082-8491 |
Practice Address - Country: | US |
Practice Address - Phone: | 203-293-8554 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-10-08 |
Last Update Date: | 2022-01-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CT | 002771 | 251B00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251B00000X | Agencies | Case Management |