Provider Demographics
NPI:1669593182
Name:DAVIS'LIBRE, MARY CAROLE (LPC)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:CAROLE
Last Name:DAVIS'LIBRE
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 1:3500 VIRGINIA BEACH BLVD
Mailing Address - Street 2:SUITE 210 MARY C. DAVIS'LIBRE, LPC
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-4445
Mailing Address - Country:US
Mailing Address - Phone:757-376-7121
Mailing Address - Fax:757-416-5236
Practice Address - Street 1:3500 VIRGINIA BEACH BLVD
Practice Address - Street 2:SUITE 210 MARY C. DAVIS'LIBRE, LPC
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-4445
Practice Address - Country:US
Practice Address - Phone:757-376-7121
Practice Address - Fax:757-416-5236
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003407101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1669593182Medicaid