Provider Demographics
NPI:1427513209
Name:CRESWELL, LARYSSA M (MT-BC, LCPC, LPC,ACS)
Entity type:Individual
Prefix:DR
First Name:LARYSSA
Middle Name:M
Last Name:CRESWELL
Suffix:
Gender:F
Credentials:MT-BC, LCPC, LPC,ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 OLD SOLOMONS ISLAND ROAD
Mailing Address - Street 2:SUITE F
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-9215
Mailing Address - Country:US
Mailing Address - Phone:301-750-1065
Mailing Address - Fax:
Practice Address - Street 1:139 OLD SOLOMONS ISLAND ROAD
Practice Address - Street 2:SUITE F
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1898
Practice Address - Country:US
Practice Address - Phone:301-750-1065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-05
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225A00000X
MDLC6298101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist