Provider Demographics
NPI:1972278877
Name:FREEMAN, ROBERT (MED, LPC, CSAC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:MED, LPC, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 CARLISLE AVE APT 523
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23231-3340
Mailing Address - Country:US
Mailing Address - Phone:757-739-4545
Mailing Address - Fax:
Practice Address - Street 1:4912 W MARSHALL ST STE C
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3127
Practice Address - Country:US
Practice Address - Phone:804-313-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010667101YP2500X
VA0710103553101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional