Individual
LYBERTY A FORVILLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
884 W PARK AVE, PORT TOWNSEND, WA 98368-2273
(360) 385-0321
Mailing address
PO BOX 565, PORT TOWNSEND, WA 98368-0565
(360) 385-0321
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
175T00000X
Peer Specialist
Primary
CG61280509
WA
Other
Enumeration date
04/14/2022
Last updated
06/13/2022
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