Healthcare Provider Details

I. General information

NPI: 1548548480
Provider Name (Legal Business Name): SYNERGY COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2011
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 PINE HILL DR SW
SHALLOTTE NC
28470-5934
US

IV. Provider business mailing address

PO BOX 2557
SHALLOTTE NC
28459-2557
US

V. Phone/Fax

Practice location:
  • Phone: 410-299-1528
  • Fax:
Mailing address:
  • Phone: 410-299-1528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15900
License Number StateMD

VIII. Authorized Official

Name: MICHAEL MATTHEW LIBRIE
Title or Position: CLINICIAN
Credential: LCSW
Phone: 410-299-1233