Healthcare Provider Details

I. General information

NPI: 1609194208
Provider Name (Legal Business Name): MICHAEL MATTHEW LIBRIE LCSW-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2010
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: 410-299-1233
  • Fax:
Mailing address:
  • Phone: 410-299-1233
  • 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:
Title or Position:
Credential:
Phone: