Basic Information
| Provider Information | |||||||||
| NPI: | 1467416321 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LIBBY | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | MANON | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LPC MAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2817 REILLY RD | ||||||||
| Address2: | WOMACK ARMY MEDICAL CENTER MEXC-COD CREDENTIALS | ||||||||
| City: | FORT BRAGG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9109078922 | ||||||||
| FaxNumber: | 9109076069 | ||||||||
| Practice Location | |||||||||
| Address1: | BASTOGNE & REILLY ST | ||||||||
| Address2: | CLARK HEALTH CLINIC BLDG 5-4257 | ||||||||
| City: | FT BRAGG | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9109079651 | ||||||||
| FaxNumber: | 9109078229 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | LPC4077 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YA0400X | MAC16059 | IN | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.