=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518575299
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IEISHA FREEMAN LBA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2020
-----------------------------------------------------
Last Update Date | 01/20/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13 PEACH ST
-----------------------------------------------------
City | BUTLER
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31006-5338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-721-4888
-----------------------------------------------------
Fax | 478-202-9628
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13 PEACH ST
-----------------------------------------------------
City | BUTLER
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31006-5338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-721-4888
-----------------------------------------------------
Fax | 478-202-9628
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | QBA19172
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------