Provider Demographics
NPI:1396409496
Name:FREEDOM SOURCE INC
Entity Type:Organization
Organization Name:FREEDOM SOURCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PREVENTION NAVIGATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:BROOK
Authorized Official - Last Name:LOFTIS
Authorized Official - Suffix:
Authorized Official - Credentials:ALC, NCC, CPS
Authorized Official - Phone:205-874-8498
Mailing Address - Street 1:324 COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6962
Mailing Address - Country:US
Mailing Address - Phone:205-874-8498
Mailing Address - Fax:
Practice Address - Street 1:324 COMMONS DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6962
Practice Address - Country:US
Practice Address - Phone:205-874-8498
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No405300000XOther Service ProvidersPrevention ProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL7516OtherALABAMA DEPARTMENT OF MENTAL HEALTH