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

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in GA

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
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)CodeLicenseStatePrimary
Professional Counselor
Group: 193400000X SINGLE SPECIALTY GROUP
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

Other providers in Marietta, GA

All providers in Marietta, GA · Professional Counselor in Georgia

Sources for this page

Verify at the official NPI Registry.