Healthcare Provider Details

I. General information

NPI: 1235765504
Provider Name (Legal Business Name): MICHELLE SUMMER LIBBY LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2020
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 CHESTNUT ST
LEXINGTON NC
27292-2313
US

IV. Provider business mailing address

107 CHESTNUT ST
LEXINGTON NC
27292-2313
US

V. Phone/Fax

Practice location:
  • Phone: 336-422-6699
  • Fax: 336-217-8813
Mailing address:
  • Phone: 336-422-6699
  • Fax: 336-217-8813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number16218
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: