Provider Demographics
NPI:1700543725
Name:FREUDIG, ANTONY KARL (LCPC (CONDITIONAL))
Entity type:Individual
Prefix:MR
First Name:ANTONY
Middle Name:KARL
Last Name:FREUDIG
Suffix:
Gender:M
Credentials:LCPC (CONDITIONAL)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 134
Mailing Address - Street 2:
Mailing Address - City:BERNARD
Mailing Address - State:ME
Mailing Address - Zip Code:04612-0134
Mailing Address - Country:US
Mailing Address - Phone:207-244-3105
Mailing Address - Fax:
Practice Address - Street 1:49 MACKENZIE LANE
Practice Address - Street 2:
Practice Address - City:BERNARD
Practice Address - State:ME
Practice Address - Zip Code:04612-0461
Practice Address - Country:US
Practice Address - Phone:207-244-3105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-24
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL5273101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional