Provider Demographics
NPI:1508876962
Name:LIEBGOLD, LARRY (LPC)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:LIEBGOLD
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 RIVER BEND BLVD
Mailing Address - Street 2:
Mailing Address - City:INDIAN LAND
Mailing Address - State:SC
Mailing Address - Zip Code:29707-5523
Mailing Address - Country:US
Mailing Address - Phone:720-530-0500
Mailing Address - Fax:
Practice Address - Street 1:10800 SIKES PL STE 300
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-8124
Practice Address - Country:US
Practice Address - Phone:720-530-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13662101YP2500X
NC13997101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional