Provider Demographics
NPI:1932973310
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:MR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:ALDEN
Authorized Official - Last Name:BROUSSARD
Authorized Official - Suffix:II
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:443-788-2874
Mailing Address - Street 1:11201 POPLAR GROVE CT
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-3536
Mailing Address - Country:US
Mailing Address - Phone:443-788-2874
Mailing Address - Fax:
Practice Address - Street 1:11201 POPLAR GROVE CT
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-3536
Practice Address - Country:US
Practice Address - Phone:443-788-2874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty