Healthcare Provider Details

I. General information

NPI: 1942019583
Provider Name (Legal Business Name): LIBERTY TREATMENT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2025
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 H2O PL STE 11
HAMPSTEAD NC
28443
US

IV. Provider business mailing address

1144 WESTERN BLVD # 1122
JACKSONVILLE NC
28546-6651
US

V. Phone/Fax

Practice location:
  • Phone: 910-996-3115
  • Fax: 910-613-0016
Mailing address:
  • Phone: 910-996-3115
  • Fax: 910-613-0016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: GINA ROSE
Title or Position: OWNER
Credential: LCSW
Phone: 959-226-8411