Provider Demographics
NPI:1558419184
Name:CAMPBELL, LIBBY THEO (PHD LMHC)
Entity Type:Individual
Prefix:DR
First Name:LIBBY
Middle Name:THEO
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PHD LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10312 POINTVIEW CRT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836
Mailing Address - Country:US
Mailing Address - Phone:407-354-0430
Mailing Address - Fax:407-354-0430
Practice Address - Street 1:7345 SANDLAKE RD
Practice Address - Street 2:#409
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819
Practice Address - Country:US
Practice Address - Phone:407-354-0430
Practice Address - Fax:407-354-0430
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH00003126101Y00000X
NBCC44397101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ6446OtherBCBS