Provider Demographics
NPI:1184342537
Name:LIMINAL SPACE ART THERAPY LLC
Entity type:Organization
Organization Name:LIMINAL SPACE ART THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMA
Authorized Official - Middle Name:
Authorized Official - Last Name:KYERE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, LCPAT
Authorized Official - Phone:240-801-5902
Mailing Address - Street 1:1009 FREDERICK RD
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-5055
Mailing Address - Country:US
Mailing Address - Phone:240-801-5902
Mailing Address - Fax:
Practice Address - Street 1:1009 FREDERICK RD
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-5055
Practice Address - Country:US
Practice Address - Phone:240-801-5902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health