Provider Demographics
NPI:1316767817
Name:LIBERATION COUNSELING LLC
Entity type:Organization
Organization Name:LIBERATION COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DORIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHULAWDE
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:216-832-0804
Mailing Address - Street 1:16781 CHAGRIN BLVD # 166
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-3721
Mailing Address - Country:US
Mailing Address - Phone:216-832-0804
Mailing Address - Fax:
Practice Address - Street 1:21403 CHAGRIN BLVD STE 210
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5322
Practice Address - Country:US
Practice Address - Phone:216-832-0804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-10
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health