Provider Demographics
NPI:1144625922
Name:FREEMAN, GRANVILLE THEODORE III (LPC, NCC, DCC, GCDF)
Entity type:Individual
Prefix:MR
First Name:GRANVILLE
Middle Name:THEODORE
Last Name:FREEMAN
Suffix:III
Gender:M
Credentials:LPC, NCC, DCC, GCDF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 720
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30086
Mailing Address - Country:US
Mailing Address - Phone:404-913-0557
Mailing Address - Fax:404-393-7401
Practice Address - Street 1:5000 BRITTANY DRIVE
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083
Practice Address - Country:US
Practice Address - Phone:404-538-1791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008077101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional