Provider Demographics
NPI:1225670193
Name:FREEMAN, SAMANTHA RENEE
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:RENEE
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:PO BOX 1192
Mailing Address - Street 2:
Mailing Address - City:SHARPSBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27878-1192
Mailing Address - Country:US
Mailing Address - Phone:919-904-8128
Mailing Address - Fax:
Practice Address - Street 1:3406 WETHERLY DR N APT B
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-1290
Practice Address - Country:US
Practice Address - Phone:919-904-8128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-12
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1041C0700X
NCP0142361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical