Provider Demographics
NPI:1275027088
Name:FEARLESS GROWTH THERAPEUTIC SERVICES, LLC
Entity Type:Organization
Organization Name:FEARLESS GROWTH THERAPEUTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CIARA
Authorized Official - Middle Name:
Authorized Official - Last Name:COOKS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:443-735-1300
Mailing Address - Street 1:1703 S KAYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-8652
Mailing Address - Country:US
Mailing Address - Phone:443-735-1300
Mailing Address - Fax:
Practice Address - Street 1:225 N DIVISION ST RM 207
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-4302
Practice Address - Country:US
Practice Address - Phone:410-603-3104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-15
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)