Provider Demographics
NPI:1689741993
Name:FREEMAN, KEVIN ANDREW (PHD, LPC, NCC, MAC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ANDREW
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:PHD, LPC, NCC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WESTPARK DR
Mailing Address - Street 2:SUITE 325
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-3534
Mailing Address - Country:US
Mailing Address - Phone:770-486-1140
Mailing Address - Fax:678-669-2693
Practice Address - Street 1:200 WESTPARK DR
Practice Address - Street 2:SUITE 325
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-3534
Practice Address - Country:US
Practice Address - Phone:770-486-1140
Practice Address - Fax:678-669-2693
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4897101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52212904001OtherBCBS
7835951OtherAETNA
60073521OtherMAGELLAN
7835951OtherAETNA
GA307300653AMedicare PIN