Provider Demographics
NPI:1104205970
Name:FREEMAN, MARY MEGAN (LCSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:MEGAN
Last Name:FREEMAN
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 ROCK MERRITT AVE BLDG 4-3219
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310-0001
Mailing Address - Country:US
Mailing Address - Phone:910-907-6999
Mailing Address - Fax:910-570-3048
Practice Address - Street 1:2817 ROCK MERRITT AVE BLDG 4-3219
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-0001
Practice Address - Country:US
Practice Address - Phone:910-907-6999
Practice Address - Fax:910-570-3048
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0108431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1104205970Medicaid