Provider Demographics
NPI:1548099146
Name:FRESH INSIGHTS COUNSELING PC
Entity type:Organization
Organization Name:FRESH INSIGHTS COUNSELING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GEANETTA
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:AGBONA
Authorized Official - Suffix:
Authorized Official - Credentials:CPC CRC CPC-I
Authorized Official - Phone:704-254-7900
Mailing Address - Street 1:7704 ENGLAND ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-5954
Mailing Address - Country:US
Mailing Address - Phone:704-965-5015
Mailing Address - Fax:
Practice Address - Street 1:7704 ENGLAND ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-5954
Practice Address - Country:US
Practice Address - Phone:704-965-5015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-31
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty