Provider Demographics
NPI:1659762128
Name:PIEDMONT COUNSELING AND DEVELOPMENT GROUP
Entity Type:Organization
Organization Name:PIEDMONT COUNSELING AND DEVELOPMENT GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:828-320-8807
Mailing Address - Street 1:305 4TH ST SW
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-2820
Mailing Address - Country:US
Mailing Address - Phone:828-270-2840
Mailing Address - Fax:
Practice Address - Street 1:305 4TH ST SW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-2820
Practice Address - Country:US
Practice Address - Phone:828-270-3840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-05
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC834103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty