Provider Demographics
NPI:1154157246
Name:FREEMAN, TAYLOR (MA, LCMHCA)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:MA, LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4318 GREENLEAF ST NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-0268
Mailing Address - Country:US
Mailing Address - Phone:704-787-4978
Mailing Address - Fax:
Practice Address - Street 1:170 DAVIDSON HWY STE 203
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-4255
Practice Address - Country:US
Practice Address - Phone:704-918-5131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA205536101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health