Provider Demographics
NPI:1154678225
Name:FREEMAN, JAMES TERRELL (LCSW, PHD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:TERRELL
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:LCSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2943 AUDREY DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-7269
Mailing Address - Country:US
Mailing Address - Phone:443-203-8405
Mailing Address - Fax:
Practice Address - Street 1:2943 AUDREY DR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-7269
Practice Address - Country:US
Practice Address - Phone:443-203-8405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0079011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC007901OtherNORTH CAROLINA SOCIAL WORK CERTIFICATION AND LICENSURE BOARD