Provider Demographics
NPI:1417566605
Name:FREEDOM FAMILY COUNSELING GROUP CORP.
Entity Type:Organization
Organization Name:FREEDOM FAMILY COUNSELING GROUP CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-310-1681
Mailing Address - Street 1:5063 MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-9468
Mailing Address - Country:US
Mailing Address - Phone:707-310-1681
Mailing Address - Fax:
Practice Address - Street 1:190 S ORCHARD AVE STE C230
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-3657
Practice Address - Country:US
Practice Address - Phone:707-634-4863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health