1588793095 NPI number — MRS. MARY TERESA FREEMAN-WALTERS MS, MAC, LPC, CPCS

Table of content: MRS. MARY TERESA FREEMAN-WALTERS MS, MAC, LPC, CPCS (NPI 1588793095)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588793095 NPI number — MRS. MARY TERESA FREEMAN-WALTERS MS, MAC, LPC, CPCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FREEMAN-WALTERS
Provider First Name:
MARY
Provider Middle Name:
TERESA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, MAC, LPC, CPCS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FREEMAN
Provider Other First Name:
MARY
Provider Other Middle Name:
TERESA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, MAC,LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1588793095
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3237 SOUTH CHEROKEE LANE
Provider Second Line Business Mailing Address:
#1110
Provider Business Mailing Address City Name:
WOODSTOCK
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30188-4793
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-239-7453
Provider Business Mailing Address Fax Number:
678-658-8177

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3237 SOUTH CHEROKEE LANE
Provider Second Line Business Practice Location Address:
#1110
Provider Business Practice Location Address City Name:
WOODSTOCK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30188-4793
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-239-7453
Provider Business Practice Location Address Fax Number:
678-658-8177
Provider Enumeration Date:
03/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  002671 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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