Healthcare Provider Details

I. General information

NPI: 1578267936
Provider Name (Legal Business Name): LIBERATION THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 03/29/2023
Certification Date: 03/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9613 HARFORD RD STE C #1210
BALTIMORE MD
21234-2150
US

IV. Provider business mailing address

9613 HARFORD RD STE C #1210
BALTIMORE MD
21234-2150
US

V. Phone/Fax

Practice location:
  • Phone: 202-921-1107
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TERESA CRENSHAW
Title or Position: OWNER/ THERAPIST
Credential: LCSW-C, LICSW
Phone: 202-921-1107