Fresh Start Community Developers, LLC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

236 Issued in GA

Legal business name

FRESH START COMMUNITY DEVELOPERS, LLC

Practice address

46 Sycamore Sta
Decatur, GA 30030-2757

Phone

(404) 245-9265

Fax

(404) 370-1202

NPI assigned

Jul 25, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Kirk Michael Williams, MS, CADC, ICRC, SAM

Title

Certified Addiction Counselor

Phone

(404) 245-9265

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1343174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343174400000",
    "number": "1114273315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "46 SYCAMORE STA",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300302757",
            "telephone_number": "404-245-9265",
            "fax_number": "404-370-1202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "46 SYCAMORE STA",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300302757",
            "telephone_number": "404-245-9265",
            "fax_number": "404-370-1202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRESH START COMMUNITY DEVELOPERS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-25",
        "last_updated": "2012-07-25",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "KIRK",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "CERTIFIED ADDICTION COUNSELOR",
        "authorized_official_telephone_number": "404-245-9265",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MS, CADC, ICRC, SAM"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "GA",
            "license": "236",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Addiction (Substance Use Disorder) Counselor in Decatur, GA
• Providers in Decatur, GA by specialty
• Addiction (Substance Use Disorder) Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.