Healthcare Provider Details

I. General information

NPI: 1649979949
Provider Name (Legal Business Name): FREEURMIND COUNSELINGAND SUPPORTIVE SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 02/27/2023
Certification Date: 02/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 OWEN DR STE 10
FAYETTEVILLE NC
28304-3412
US

IV. Provider business mailing address

7125 DAYSPRING DR
FAYETTEVILLE NC
28314-6532
US

V. Phone/Fax

Practice location:
  • Phone: 910-317-9205
  • Fax:
Mailing address:
  • Phone: 910-818-0728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: LAVONDRA BOYD
Title or Position: OWNER
Credential:
Phone: 910-818-0728