Provider Demographics
NPI:1124201793
Name:FREEDOM COUNSELING CENTER INC
Entity Type:Organization
Organization Name:FREEDOM COUNSELING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:ASHCRAFT
Authorized Official - Last Name:PUCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:318-641-0008
Mailing Address - Street 1:2801 DONAHUE FERRY ROAD
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360
Mailing Address - Country:US
Mailing Address - Phone:318-641-0008
Mailing Address - Fax:318-641-1685
Practice Address - Street 1:2801 DONAHUE FERRY RD
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-4513
Practice Address - Country:US
Practice Address - Phone:318-641-0008
Practice Address - Fax:318-641-1685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3066251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CD48Medicare UPIN