Provider Demographics
NPI:1699582684
Name:PHOENIX FREEDOM ACADEMY
Entity type:Organization
Organization Name:PHOENIX FREEDOM ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:QUORNELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HYPOLITE
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA-D
Authorized Official - Phone:407-232-2726
Mailing Address - Street 1:1707 TERRA COTA CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-8904
Mailing Address - Country:US
Mailing Address - Phone:407-232-2726
Mailing Address - Fax:
Practice Address - Street 1:1707 TERRA COTA CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-8904
Practice Address - Country:US
Practice Address - Phone:407-232-2726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-13
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty