Healthcare Provider Details

I. General information

NPI: 1578890430
Provider Name (Legal Business Name): LINDA WINCHELL LYBARGER LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2009
Last Update Date: 05/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 NORTHGATE PLAZA SUITE 11
MORRISVILLE VT
05661-5900
US

IV. Provider business mailing address

258 FARM HILL RD
MORRISTOWN VT
05661-8721
US

V. Phone/Fax

Practice location:
  • Phone: 802-888-8320
  • Fax: 802-888-8136
Mailing address:
  • Phone: 802-888-2223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: