Healthcare Provider Details

I. General information

NPI: 1871873471
Provider Name (Legal Business Name): LIBERTY MEDICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2011
Last Update Date: 08/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8308 LIBERTY RD
BALTIMORE MD
21244-3124
US

IV. Provider business mailing address

9919 HOYT CIR
RANDALLSTOWN MD
21133-1603
US

V. Phone/Fax

Practice location:
  • Phone: 410-491-5066
  • Fax:
Mailing address:
  • Phone: 410-491-5066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. VANESSA L EDWARDS
Title or Position: EXECUTIVE
Credential: MSW, LGSW
Phone: 410-491-5066