Provider Demographics
NPI:1164678918
Name:SLOCOMB, JOHN TIBBITTS
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:TIBBITTS
Last Name:SLOCOMB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JACK
Other - Middle Name:
Other - Last Name:SLOCOMB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:134 BALTIMORE ST
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-2302
Mailing Address - Country:US
Mailing Address - Phone:301-777-0620
Mailing Address - Fax:301-777-2906
Practice Address - Street 1:134 BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2302
Practice Address - Country:US
Practice Address - Phone:301-777-0620
Practice Address - Fax:301-777-2906
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04526101YM0800X
MD042561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical