Provider Demographics
NPI:1922107333
Name:DIBBS, MARY NAJWA (LPC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:NAJWA
Last Name:DIBBS
Suffix:
Gender:F
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:PO BOX 51742
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-1742
Mailing Address - Country:US
Mailing Address - Phone:337-769-8508
Mailing Address - Fax:337-769-8509
Practice Address - Street 1:105 CORPORATE BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508
Practice Address - Country:US
Practice Address - Phone:337-769-8508
Practice Address - Fax:337-769-8509
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACI3357101YP2500X
LA3357101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional