Provider Demographics
NPI:1568743193
Name:WATSON, LIBBY (LIBBY WATSON, LPC)
Entity Type:Individual
Prefix:
First Name:LIBBY
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:LIBBY WATSON, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 COBB PKWY NW
Mailing Address - Street 2:SUITE 603
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-9532
Mailing Address - Country:US
Mailing Address - Phone:770-778-4130
Mailing Address - Fax:
Practice Address - Street 1:3950 COBB PKWY NW
Practice Address - Street 2:SUITE 603
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-9532
Practice Address - Country:US
Practice Address - Phone:770-778-4130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006514101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional