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General NPI Number Information
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NPI Number | 1942019583
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Entity Type | Organization
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Legal Business Name | LIBERTY TREATMENT PLLC
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Dates
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Enumeration Date | 01/07/2025
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 13500 NC HIGHWAY 50 STE 210
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City | SURF CITY
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State | NC
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Zip | 28445-7934
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Country | US
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Telephone | 910-239-4811
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Fax | 910-613-0016
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Provider Business Mailing Address
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Address Line | 1144 WESTERN BLVD # 1122
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City | JACKSONVILLE
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State | NC
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Zip | 28546-6651
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Country | US
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Telephone | 910-996-3115
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GINA ROSE
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Credential | LCSW
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Telephone | 959-226-8411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #5
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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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