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Individual
MR. MICCO LEWIS FREEMAN
Active
Individual
MR. MICCO LEWIS FREEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
NONE
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
06/16/2015
Last updated
01/23/2020
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