Provider Demographics
NPI:1538334685
Name:FREEMAN, ERICKA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ERICKA
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 HIDEAWAY LN E
Mailing Address - Street 2:
Mailing Address - City:HIDEAWAY
Mailing Address - State:TX
Mailing Address - Zip Code:75771-5215
Mailing Address - Country:US
Mailing Address - Phone:817-774-8420
Mailing Address - Fax:
Practice Address - Street 1:428 HIDEAWAY LN E
Practice Address - Street 2:
Practice Address - City:HIDEAWAY
Practice Address - State:TX
Practice Address - Zip Code:75771-5215
Practice Address - Country:US
Practice Address - Phone:817-774-8420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2022-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40278171M00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4064206Medicaid