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General NPI Number Information
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NPI Number | 1699555664
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Entity Type | Organization
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Legal Business Name | LIBERATION PATHWAYS LLC
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Dates
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Enumeration Date | 10/05/2023
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Last Update Date | 06/10/2024
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Provider Practice Location Address
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Address Line | 470 W BROAD ST # 1257
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City | COLUMBUS
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State | OH
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Zip | 43215-2759
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Country | US
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Telephone | 614-953-4368
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Fax | 614-999-9491
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Provider Business Mailing Address
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Address Line | 470 W BROAD ST # 1257
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City | COLUMBUS
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State | OH
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Zip | 43215-2759
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Country | US
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Telephone | 614-953-4368
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICAL SOCIAL WORKER
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Name | MONICA DAVIS
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Credential | LISW
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Telephone | 614-953-4368
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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