Provider Demographics
NPI:1720821028
Name:FRESH START COUNSELING LLC
Entity type:Organization
Organization Name:FRESH START COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DYMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:TATEM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:609-503-0484
Mailing Address - Street 1:1025 CRESTWOOD CT
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-2176
Mailing Address - Country:US
Mailing Address - Phone:609-503-0484
Mailing Address - Fax:609-503-0484
Practice Address - Street 1:300 THOMAS AVE BLDG 501A
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094-3442
Practice Address - Country:US
Practice Address - Phone:609-503-0484
Practice Address - Fax:609-503-0484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty