Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003233404 |
---|---|
Provider Name | Mr. Laurence Freedom |
First Address | Lakewood, CO 80215 |
Second Address | Colorado Springs, CO 80920 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2014 |
Last Update Date | 24/03/2014 |