Healthcare Provider Details

I. General information

NPI: 1427513209
Provider Name (Legal Business Name): LARYSSA M CRESWELL MT-BC, LCPC, LPC,ACS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2019
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 OLD SOLOMONS ISLAND ROAD SUITE F
ANNAPOLIS MD
21401-1898
US

IV. Provider business mailing address

139 OLD SOLOMONS ISLAND ROAD SUITE F
ANNAPOLIS MD
21401-9215
US

V. Phone/Fax

Practice location:
  • Phone: 301-750-1065
  • Fax:
Mailing address:
  • Phone: 301-750-1065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC6298
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: