Organization
FRESH START FAMILY THERAPY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BRIDGET JUANIQUE LARK LMFT (OWNER)
(856) 220-7035
Entity
Organization
Contact information
Practice address
600 SOMERDALE RD STE 101, VOORHEES, NJ 08043-1858
(856) 220-7035
(856) 595-9377
Mailing address
38 WALNUT AVE, LINDENWOLD, NJ 08021-1635
(856) 220-7035
(856) 595-9377
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1386125946
—
NJ
Enumeration date
06/29/2020
Last updated
06/29/2020
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