Provider Demographics
NPI:1447966791
Name:FREELAND, STACY ANN (LICENSED PROFESSIONA)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:ANN
Last Name:FREELAND
Suffix:
Gender:F
Credentials:LICENSED PROFESSIONA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12176 CALLDO ROAD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2740
Mailing Address - Country:US
Mailing Address - Phone:314-629-8683
Mailing Address - Fax:
Practice Address - Street 1:12176 CALLDO ROAD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2740
Practice Address - Country:US
Practice Address - Phone:314-629-8683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003031564101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional