Provider Demographics
NPI:1104116383
Name:LIBERATED SOLUTIONS CONSULTING SERVICES, LLC
Entity type:Organization
Organization Name:LIBERATED SOLUTIONS CONSULTING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:S
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-217-0914
Mailing Address - Street 1:3405 SWEETWATER RD
Mailing Address - Street 2:APT. 721
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-2445
Mailing Address - Country:US
Mailing Address - Phone:770-217-0914
Mailing Address - Fax:
Practice Address - Street 1:3405 SWEETWATER RD
Practice Address - Street 2:APT. 721
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-2445
Practice Address - Country:US
Practice Address - Phone:770-217-0914
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-09
Last Update Date:2011-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management