Provider Demographics
NPI:1316067655
Name:FREEMAN-ABBOTT, WANDA (LCSW)
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:
Last Name:FREEMAN-ABBOTT
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 1:384 VINCENT DR
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:NC
Mailing Address - Zip Code:27842-9226
Mailing Address - Country:US
Mailing Address - Phone:252-537-1187
Mailing Address - Fax:
Practice Address - Street 1:215 W ATLANTIC ST
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:VA
Practice Address - Zip Code:23847-1223
Practice Address - Country:US
Practice Address - Phone:434-634-5181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0030771041C0700X
VA0940010851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE