Organization
FRESH START RECOVERY
Active
Other names
FRESH START CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
CATHY PICILLO (OFFICE MANAGER)
(954) 234-2469
Entity
Organization
Contact information
Practice address
15886 GAITHER DR, GAITHERSBURG, MD 20877-1404
(954) 234-2469
(954) 234-2469
Mailing address
15886 GAITHER DR, GAITHERSBURG, MD 20877-1404
(954) 234-2469
(954) 234-2469
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
Primary
D0046457
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D0046457
STATE
FL
Enumeration date
02/20/2017
Last updated
02/20/2017
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