Provider Demographics
NPI:1811514078
Name:FREEDOM WINGS COUNSELING, PLLC
Entity type:Organization
Organization Name:FREEDOM WINGS COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC,SDP-A
Authorized Official - Phone:870-754-6777
Mailing Address - Street 1:PO BOX 2833
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72602-2833
Mailing Address - Country:US
Mailing Address - Phone:870-754-6777
Mailing Address - Fax:
Practice Address - Street 1:303 N MAIN ST STE 104B
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-3508
Practice Address - Country:US
Practice Address - Phone:870-754-6777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-02
Last Update Date:2020-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty