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General NPI Number Information
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NPI Number | 1255646816
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Entity Type | Organization
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Legal Business Name | WILLIAM 'BILL' FREEMAN FOUNDATION INC.
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Dates
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Enumeration Date | 08/07/2010
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Last Update Date | 08/07/2010
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Provider Practice Location Address
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Address Line | 604 GLEN IRIS DR NE
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City | ATLANTA
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State | GA
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Zip | 30308-2717
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Country | US
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Telephone | 336-306-3738
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Fax |
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Provider Business Mailing Address
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Address Line | 604 GLEN IRIS DR NE
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City | ATLANTA
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State | GA
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Zip | 30308-2717
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. BRIAN BOWLES
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Credential |
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Telephone | 336-306-3738
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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