| Doctor Name: | JACK LIEB |
| NPI Number: | 1336565118 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 3017 |
| Business Practice Address: | 100 Matheson St Bennettsville, SC - 295124034 |
| Business Phone Number: | 8434542038 |
| Business Fax Number: | |
| Mailing Address: | 100 Matheson St, BENNETTSVILLE |
| State: | SC |
| Postal Code: | 295124034 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 03/17/2014 |
| NPI Last Update Date: | 03/17/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TS0200X |
| License Number: | 3017 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |