Provider Demographics
NPI:1750036075
Name:LIBERATION CENTERED HEALING, LLC
Entity Type:Organization
Organization Name:LIBERATION CENTERED HEALING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:SANIYAH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:734-717-2136
Mailing Address - Street 1:7688 ELLENS WAY ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9528
Mailing Address - Country:US
Mailing Address - Phone:734-717-2136
Mailing Address - Fax:
Practice Address - Street 1:7688 ELLENS WAY ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9528
Practice Address - Country:US
Practice Address - Phone:734-717-2136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health