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General NPI Number Information
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NPI Number | 1558419184
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Entity Type | Individual
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Provider Name | LIBBY THEO CAMPBELL PHD LMHC
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Gender | Female
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7345 SANDLAKE RD #409
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City | ORLANDO
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State | FL
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Zip | 32819
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Country | US
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Telephone | 407-354-0430
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Fax | 407-354-0430
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Provider Business Mailing Address
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Address Line | 10312 POINTVIEW CRT
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City | ORLANDO
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State | FL
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Zip | 32836
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Country | US
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Telephone | 407-354-0430
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Fax | 407-354-0430
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | MH00003126
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | NBCC44397
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License Number State |
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