MEDICARE: MS. LINDA MANON LIBBY LPC MAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	LPC4077	NC
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	MAC16059	IN

General Provider Information

NPI Number	:	1467416321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LINDA MANON LIBBY LPC MAC

Provider Business Mailing Address
First Line	:	2817 REILLY RD
Second Line	:	WOMACK ARMY MEDICAL CENTER MEXC-COD CREDENTIALS
City	:	FORT BRAGG
State	:	NC
Zip	:	28310
Country	:	US
Telephone Number	:	910-907-8922
Fax Number	:	910-907-6069

Provider Business Practice Location Address
First Line	:	BASTOGNE & REILLY ST
Second Line	:	CLARK HEALTH CLINIC BLDG 5-4257
City	:	FT BRAGG
State	:	NC
Zip	:	28310
Country	:	US
Telephone Number	:	910-907-9651
Fax Number	:	910-907-8229

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	07/08/2007

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