Organization
FRESH START THERAPEUTIC SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TEKORA NICHOLS LCSW-C (REHABILITATION SPECIALIST)
(240) 370-9479
Entity
Organization
Contact information
Practice address
626 TOWNE CENTER DR STE 204, JOPPA, MD 21085-4451
(443) 313-3240
(443) 313-3234
Mailing address
1307 LIATRIS LN, BELCAMP, MD 21017-1660
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
07/22/2020
Last updated
07/22/2020
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