Provider Demographics
NPI:1629355672
Name:FREEMAN, MIRANDA (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:
Other - Last Name:REDDICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFTA
Mailing Address - Street 1:401 HAWTHORNE LN STE 110-205
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2484
Mailing Address - Country:US
Mailing Address - Phone:980-216-8886
Mailing Address - Fax:
Practice Address - Street 1:401 HAWTHORNE LN STE 110-205
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2484
Practice Address - Country:US
Practice Address - Phone:980-216-8886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-04
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2348106H00000X
NC7079A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist