Healthcare Provider Details

I. General information

NPI: 1740386101
Provider Name (Legal Business Name): FREDDIE MAE EVERETT-LEE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FREDDIE MAE EVERETT-LEE LCSW

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 03/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USAMEDDAC, SOCIAL WORK SVCS, BLDG9200 MACH
FORT BENNING GA
31905-4004
US

IV. Provider business mailing address

3700 BRIDGEWATER RD H-2
COLUMBUS GA
31909-4767
US

V. Phone/Fax

Practice location:
  • Phone: 706-544-4418
  • Fax: 706-544-4458
Mailing address:
  • Phone: 770-266-8399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC303403
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: