Provider Demographics
NPI:1699555664
Name:LIBERATION PATHWAYS LLC
Entity type:Organization
Organization Name:LIBERATION PATHWAYS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:614-953-4368
Mailing Address - Street 1:470 W BROAD ST # 1257
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-2759
Mailing Address - Country:US
Mailing Address - Phone:614-953-4368
Mailing Address - Fax:
Practice Address - Street 1:470 W BROAD ST # 1257
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-2759
Practice Address - Country:US
Practice Address - Phone:614-953-4368
Practice Address - Fax:614-999-9491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-05
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHI.2103264OtherCOUNSELOR, SOCIAL WORKER, AND MARRIAGE & FAMILY THERAPY BOARD LICENSE #
1508350836OtherNPI (INDIVIDUAL PROVIDER) IDENTIFIER