Provider Demographics
NPI:1225472160
Name:FREEMAN, MICKIA
Entity Type:Individual
Prefix:MRS
First Name:MICKIA
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11135 GOLDENROD FERN DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-2231
Mailing Address - Country:US
Mailing Address - Phone:540-907-9102
Mailing Address - Fax:
Practice Address - Street 1:11135 GOLDENROD FERN DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-2231
Practice Address - Country:US
Practice Address - Phone:540-907-9102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-22
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator