Provider Demographics
NPI:1588793095
Name:FREEMAN-WALTERS, MARY TERESA (MS, MAC, LPC, CPCS)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:TERESA
Last Name:FREEMAN-WALTERS
Suffix:
Gender:F
Credentials:MS, MAC, LPC, CPCS
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:TERESA
Other - Last Name:FREEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, MAC,LPC
Mailing Address - Street 1:3237 SOUTH CHEROKEE LANE
Mailing Address - Street 2:#1110
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-4793
Mailing Address - Country:US
Mailing Address - Phone:770-239-7453
Mailing Address - Fax:678-658-8177
Practice Address - Street 1:3237 SOUTH CHEROKEE LANE
Practice Address - Street 2:#1110
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-4793
Practice Address - Country:US
Practice Address - Phone:770-239-7453
Practice Address - Fax:678-658-8177
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002671101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional