Provider Demographics
NPI:1043531445
Name:BARIUM SPRINGS FREEDOM ACADEMY
Entity Type:Organization
Organization Name:BARIUM SPRINGS FREEDOM ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CELESTE
Authorized Official - Middle Name:I
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:MA CHC
Authorized Official - Phone:704-880-2316
Mailing Address - Street 1:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:BARIUM SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28010-0001
Mailing Address - Country:US
Mailing Address - Phone:704-873-1011
Mailing Address - Fax:704-924-7683
Practice Address - Street 1:2776 YELLOW BANKS RD
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-8861
Practice Address - Country:US
Practice Address - Phone:336-667-1121
Practice Address - Fax:336-696-4183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-20
Last Update Date:2010-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL 097 063251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCMHL 097 063OtherDHSR LICENSE