Provider Demographics
NPI:1619182706
Name:LIBETHE, JOYCE ANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:ANNE
Last Name:LIBETHE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7148 WESSYNTON DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-7549
Mailing Address - Country:US
Mailing Address - Phone:704-544-0003
Mailing Address - Fax:704-540-0202
Practice Address - Street 1:7148 WESSYNTON DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-7549
Practice Address - Country:US
Practice Address - Phone:704-544-0003
Practice Address - Fax:704-540-0202
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1998103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral