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General NPI Number Information
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NPI Number | 1033053681
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Entity Type | Organization
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Legal Business Name | LEAD FREELY LICENSED CLINICAL SOCIAL WORKER PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 04/15/2026
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Last Update Date | 04/15/2026
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Provider Practice Location Address
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Address Line | 2008 3RD AVE N
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City | BIRMINGHAM
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State | AL
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Zip | 35203-3332
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Country | US
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Telephone | 205-899-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 3964 RIVERMARK PLZ STE 2743
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City | SANTA CLARA
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State | CA
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Zip | 95054-4155
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Country | US
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Telephone | 510-457-1004
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | ASHLEY GENEVA WALAY
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Credential | LCSW
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Telephone | 510-457-1004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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