Provider Demographics
NPI:1417575770
Name:FREEMAN, RONNAL DEMEKO (LPC, MT-BC)
Entity Type:Individual
Prefix:
First Name:RONNAL
Middle Name:DEMEKO
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:LPC, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 E CLIVEDEN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-2321
Mailing Address - Country:US
Mailing Address - Phone:704-219-9190
Mailing Address - Fax:
Practice Address - Street 1:600 HAVERFORD RD STE 201
Practice Address - Street 2:
Practice Address - City:HAVERFORD
Practice Address - State:PA
Practice Address - Zip Code:19041-1139
Practice Address - Country:US
Practice Address - Phone:610-664-2524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012343101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional