Provider Demographics
NPI:1720002553
Name:LIBBY, CHRISTANNA HARLOW (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTANNA
Middle Name:HARLOW
Last Name:LIBBY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 SUMMER ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-7144
Mailing Address - Country:US
Mailing Address - Phone:207-299-1138
Mailing Address - Fax:207-990-3660
Practice Address - Street 1:40 SUMMER ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-7144
Practice Address - Country:US
Practice Address - Phone:207-299-1138
Practice Address - Fax:207-990-3660
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC2973101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME73688869OtherAETNA
ME100454OtherANTHEM
ME431613899Medicaid