Provider Demographics
NPI:1982738456
Name:FREEMAN, KATIE (LCSW)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 N EAST AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-5226
Mailing Address - Country:US
Mailing Address - Phone:479-957-0189
Mailing Address - Fax:479-431-2548
Practice Address - Street 1:221 N EAST AVE STE 101
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-5226
Practice Address - Country:US
Practice Address - Phone:479-957-0189
Practice Address - Fax:479-431-2548
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1974-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5A356OtherBLUECROSS BLUESHIELD