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General NPI Number Information
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NPI Number | 1912576216
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Entity Type | Individual
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Provider Name | LICIA FREEMAN M.A., M.ED. LMFT
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Gender | Female
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Dates
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Enumeration Date | 06/21/2021
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Last Update Date | 06/21/2021
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Provider Practice Location Address
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Address Line | 3520 PIEDMONT RD NE STE 330
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City | ATLANTA
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State | GA
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Zip | 30305-1552
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Country | US
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Telephone | 770-352-0029
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Fax |
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Provider Business Mailing Address
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Address Line | 3520 PIEDMONT RD NE STE 330
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City | ATLANTA
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State | GA
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Zip | 30305-1552
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Country | US
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Telephone | 770-352-0029
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT36758
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT000935
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License Number State | GA
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