Provider Demographics
NPI:1245480680
Name:OVERLY, LIBBY (LCSW-C)
Entity type:Individual
Prefix:
First Name:LIBBY
Middle Name:
Last Name:OVERLY
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 JESSE HILL DRIVE SE
Mailing Address - Street 2:GRADY BEHAVIORAL HEALTH 13B
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303
Mailing Address - Country:US
Mailing Address - Phone:404-616-3330
Mailing Address - Fax:404-616-4766
Practice Address - Street 1:80 JESSE HILL DRIVE SE
Practice Address - Street 2:GRADY BEHAVIORAL HEALTH 13B
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303
Practice Address - Country:US
Practice Address - Phone:404-616-3330
Practice Address - Fax:404-616-4766
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2011-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD111941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD11194OtherMARYLAND SOCIAL WORKERS LICENSE
GACSW004274OtherLICENSED CLINICAL SOCIAL WORKER