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NPI Code Detail

MEDICARE: MARY NAJWA DIBBS LPC

MEDICARE: MARY NAJWA DIBBS LPC
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
1101YP2500XProfessional CounselorCI3357LA
2101YP2500XProfessional Counselor3357LA

General Provider Information

NPI Number : 1922107333
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY NAJWA DIBBS LPC
Provider Business Mailing Address
First Line : PO BOX 51742
Second Line :
City : LAFAYETTE
State : LA
Zip : 70505-1742
Country : US
Telephone Number : 337-769-8508
Fax Number : 337-769-8509
Provider Business Practice Location Address
First Line : 105 CORPORATE BLVD
Second Line :
City : LAFAYETTE
State : LA
Zip : 70508
Country : US
Telephone Number : 337-769-8508
Fax Number : 337-769-8509
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2006
Last Update Date : 06/28/2018

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