Provider Demographics
NPI:1861918922
Name:LIEBNER, JOHN SCOTT (MA, LPC, NCC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:SCOTT
Last Name:LIEBNER
Suffix:
Gender:M
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8217 MCCARRON WAY
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-8717
Mailing Address - Country:US
Mailing Address - Phone:704-526-0675
Mailing Address - Fax:
Practice Address - Street 1:24 CABARRUS AVE E STE 1200
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-4890
Practice Address - Country:US
Practice Address - Phone:704-567-0522
Practice Address - Fax:704-526-0675
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-20
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3072101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional