Individual
ANTIQUA LISHA LIBBEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A.
Contact information
Practice address
4821 S OUTRIGGER DR., WASILLA, AK 99687
(907) 354-4345
Mailing address
PO BOX 879461, WASILLA, AK 99687-9461
(907) 354-4345
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
AK
101YM0800X
Mental Health Counselor
Primary
—
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
$$$$$$$$$
—
AK
Enumeration date
04/29/2019
Last updated
06/13/2019
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