Provider Demographics
NPI:1588710115
Name:LYBRAND, ESMERALDA G (CDP)
Entity type:Individual
Prefix:
First Name:ESMERALDA
Middle Name:G
Last Name:LYBRAND
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34703
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1703
Mailing Address - Country:US
Mailing Address - Phone:206-764-0112
Mailing Address - Fax:206-764-0489
Practice Address - Street 1:409 CUSTER WAY SE
Practice Address - Street 2:SUITE C
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-3350
Practice Address - Country:US
Practice Address - Phone:360-570-8016
Practice Address - Fax:360-570-8275
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00005948101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)