A Breath of Fresh Air Counseling LLC
Organization Active NPI Professional Counselor · Marietta, GA
NPI 1356985303 · NPPES record last updated Aug 17, 2021
Key facts
- NPI
- 1356985303
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Professional Counselor 101YP2500X
- Legal business name
- A BREATH OF FRESH AIR COUNSELING LLC
- Practice address
- 55 Atlanta St SE
Marietta, GA 30060-1977 - Phone
- (470) 238-9475
- Fax
- (470) 533-1545
- NPI assigned
- Nov 2, 2019
- Organization subpart
- No
Authorized official
- Name
- Ms. Tanesha Danielle Walker, M.ED, LPC
- Title
- Licensed Professional Counselor
- Phone
- (470) 238-9475
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240904000734 | GA | Part B Supplier - Clinic/Group Practice | 3274073366 |
Receives reassigned benefits from 1 practitioner Practice locations: Marietta, GA |
National Provider Directory
Locations
55 Atlanta St SE
Marietta, GA 30060
Phone (470) 238-9475
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor |
101YP2500X | Yes |
Addresses
Primary practice location
55 Atlanta St SE
Marietta, GA 30060-1977
Mailing address
PO Box 158
Marietta, GA 30061-0158
Phone (773) 263-6533
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 17, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.