Provider Demographics
NPI:1285215749
Name:FREELAND, BLAISE S (LSW, LICDC)
Entity type:Individual
Prefix:
First Name:BLAISE
Middle Name:S
Last Name:FREELAND
Suffix:
Gender:F
Credentials:LSW, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 MAIN ST APT 242
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-8163
Mailing Address - Country:US
Mailing Address - Phone:863-393-5962
Mailing Address - Fax:
Practice Address - Street 1:5209 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-2224
Practice Address - Country:US
Practice Address - Phone:216-325-9109
Practice Address - Fax:216-358-0928
Is Sole Proprietor?:No
Enumeration Date:2021-04-16
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
S.23100541041C0700X
171M00000X
OHLICDC.162573101YA0400X
OHLCDCIII.162465101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care Coordinator