Provider Demographics
NPI:1669182176
Name:FEARLESSLY INSPIRED THERAPEUTIC SOLUTIONS, LLC
Entity type:Organization
Organization Name:FEARLESSLY INSPIRED THERAPEUTIC SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LARYSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRESWELL
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, LCPC, MTBC
Authorized Official - Phone:301-750-1065
Mailing Address - Street 1:139 OLD SOLOMONS ISLAND RD STE F
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-0906
Mailing Address - Country:US
Mailing Address - Phone:301-750-1065
Mailing Address - Fax:
Practice Address - Street 1:139 OLD SOLOMONS ISLAND RD STE F
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-0906
Practice Address - Country:US
Practice Address - Phone:301-750-1065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-28
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Single Specialty
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Single Specialty