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General NPI Number Information
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NPI Number | 1396409496
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Entity Type | Organization
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Legal Business Name | FREEDOM SOURCE INC
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Dates
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Enumeration Date | 10/25/2021
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Last Update Date | 05/29/2024
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Provider Practice Location Address
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Address Line | 105 VULCAN RD STE 332
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City | BIRMINGHAM
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State | AL
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Zip | 35209-4701
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Country | US
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Telephone | 205-972-8264
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Fax |
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Provider Business Mailing Address
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Address Line | 105 VULCAN RD STE 332
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City | BIRMINGHAM
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State | AL
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Zip | 35209-4701
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Country | US
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Telephone | 205-972-8264
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Fax |
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Authorized Official
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Title or Position | PREVENTION NAVIGATOR
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Name | MS. ASHLEY BROOK LOFTIS
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Credential | LPC, NCC, CPS
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Telephone | 205-972-8264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 405300000X
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Taxonomy Name | Prevention Professional
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License Number |
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License Number State |
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