Provider Demographics
NPI:1467416321
Name:LIBBY, LINDA MANON (LPC MAC)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:MANON
Last Name:LIBBY
Suffix:
Gender:F
Credentials:LPC MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 REILLY RD
Mailing Address - Street 2:WOMACK ARMY MEDICAL CENTER MEXC-COD CREDENTIALS
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310
Mailing Address - Country:US
Mailing Address - Phone:910-907-8922
Mailing Address - Fax:910-907-6069
Practice Address - Street 1:BASTOGNE & REILLY ST
Practice Address - Street 2:CLARK HEALTH CLINIC BLDG 5-4257
Practice Address - City:FT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310
Practice Address - Country:US
Practice Address - Phone:910-907-9651
Practice Address - Fax:910-907-8229
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLPC4077101YA0400X
INMAC16059101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)