Provider Demographics
NPI:1386800886
Name:LYBURN, DANITA GARRISON (BA)
Entity type:Individual
Prefix:MS
First Name:DANITA
Middle Name:GARRISON
Last Name:LYBURN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MISS
Other - First Name:DANITA
Other - Middle Name:LESLIE
Other - Last Name:GARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:5926 LARCHWOOD AVE
Mailing Address - Street 2:1ST FL
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-1139
Mailing Address - Country:US
Mailing Address - Phone:215-921-2228
Mailing Address - Fax:
Practice Address - Street 1:770 WOODLANE RD
Practice Address - Street 2:
Practice Address - City:WESTAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08060-3804
Practice Address - Country:US
Practice Address - Phone:609-267-5928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor