Provider Demographics
NPI:1063383594
Name:LIBURD, ANESA I (RBT)
Entity type:Individual
Prefix:
First Name:ANESA
Middle Name:I
Last Name:LIBURD
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:963 ASBOROUGH CT
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-5912
Mailing Address - Country:US
Mailing Address - Phone:470-913-9185
Mailing Address - Fax:
Practice Address - Street 1:963 ASBOROUGH CT
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-5912
Practice Address - Country:US
Practice Address - Phone:470-913-9185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-25-448380106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician