Provider Demographics
NPI:1982847125
Name:STAR FREEDOM
Entity Type:Organization
Organization Name:STAR FREEDOM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:PROF
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:BS-QP
Authorized Official - Phone:910-978-1424
Mailing Address - Street 1:1822 EICHELBERGER DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-6257
Mailing Address - Country:US
Mailing Address - Phone:910-978-1424
Mailing Address - Fax:
Practice Address - Street 1:1822 EICHELBERGER DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-6257
Practice Address - Country:US
Practice Address - Phone:910-978-1424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-17
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health