Provider Demographics
NPI:1811921299
Name:FREEMAN, DOUGLAS J (PHD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:J
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:828-270-3840
Mailing Address - Fax:828-270-3840
Practice Address - Street 1:106 3RD AVE NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-5014
Practice Address - Country:US
Practice Address - Phone:828-322-8736
Practice Address - Fax:828-322-7890
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC834103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2810472Medicare PIN