Provider Demographics
NPI:1477974277
Name:KELLEY-FREEMAN, ANDREA MARIA (MS)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIA
Last Name:KELLEY-FREEMAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:MARIA
Other - Last Name:KELLEY-FREEMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCADC, LCPC
Mailing Address - Street 1:8737 BROOKS DR STE 108
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-7474
Mailing Address - Country:US
Mailing Address - Phone:800-867-2395
Mailing Address - Fax:410-443-0842
Practice Address - Street 1:8737 BROOKS DR STE 108
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-7474
Practice Address - Country:US
Practice Address - Phone:410-818-5649
Practice Address - Fax:410-819-5691
Is Sole Proprietor?:No
Enumeration Date:2013-12-20
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC8776101YS0200X, 101Y00000X, 101YM0800X
MDLCA2304405300000X, 101YP2500X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No405300000XOther Service ProvidersPrevention Professional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional