Provider Demographics
NPI:1114026762
Name:FREEMAN, CHARLOTTE M (PHD)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:M
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 UNION AVE
Mailing Address - Street 2:SUITE 709
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-3641
Mailing Address - Country:US
Mailing Address - Phone:901-726-5200
Mailing Address - Fax:901-725-3883
Practice Address - Street 1:1407 UNION AVE
Practice Address - Street 2:SUITE 709
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3641
Practice Address - Country:US
Practice Address - Phone:901-726-5200
Practice Address - Fax:901-725-3883
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3689170Medicaid
TN3080857OtherBCBS
TN2582212OtherAETNA
TN3689170Medicare ID - Type Unspecified