Provider Demographics
NPI:1295377927
Name:LIQUID THERAPY, LLC
Entity Type:Organization
Organization Name:LIQUID THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ALYCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LICSW, LCSW-C
Authorized Official - Phone:757-319-3250
Mailing Address - Street 1:410 WARFIELD DR APT 4094
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-4791
Mailing Address - Country:US
Mailing Address - Phone:757-319-3250
Mailing Address - Fax:
Practice Address - Street 1:410 WARFIELD DR APT 4094
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-4791
Practice Address - Country:US
Practice Address - Phone:757-319-3250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty