Organization
FRESH START RECOVERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICTOR ALFONSO (CEO)
(818) 212-4659
Entity
Organization
Contact information
Practice address
25 WHITLOCK PL SW STE 101, MARIETTA, GA 30064
(678) 882-0810
Mailing address
1290 KENNESTONE CIR STE A112, MARIETTA, GA 30066-6010
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
07/05/2016
Last updated
05/14/2018
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