Healthcare Provider Details

I. General information

NPI: 1730228222
Provider Name (Legal Business Name): LIBERTY FAMILY SERVICES ,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 NEWTOWN RD 509
NORFOLK VA
23502-4802
US

IV. Provider business mailing address

6330 NEWTOWN RD 509
NORFOLK VA
23502-4802
US

V. Phone/Fax

Practice location:
  • Phone: 757-466-3336
  • Fax: 757-216-4080
Mailing address:
  • Phone: 757-466-3336
  • Fax: 757-216-4080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name: SONYA OTT
Title or Position: EXEC. DIRECTOR
Credential:
Phone: 757-466-3336