Healthcare Provider Details

I. General information

NPI: 1316767817
Provider Name (Legal Business Name): LIBERATION COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21403 CHAGRIN BLVD STE 210
BEACHWOOD OH
44122-5322
US

IV. Provider business mailing address

16781 CHAGRIN BLVD # 166
SHAKER HEIGHTS OH
44120-3721
US

V. Phone/Fax

Practice location:
  • Phone: 216-832-0804
  • Fax:
Mailing address:
  • Phone: 216-400-8602
  • Fax: 216-249-9015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DORIAN MAHULAWDE
Title or Position: PRESIDENT
Credential: LPCC
Phone: 216-400-8602