Provider Demographics
NPI:1164890075
Name:TIBBS, SHONDA (LCSW)
Entity Type:Individual
Prefix:
First Name:SHONDA
Middle Name:
Last Name:TIBBS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 NORRIS RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-8024
Mailing Address - Country:US
Mailing Address - Phone:270-792-0262
Mailing Address - Fax:270-904-5110
Practice Address - Street 1:481 NORRIS RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-8024
Practice Address - Country:US
Practice Address - Phone:270-792-0262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY73291041C0700X, 104100000X
KY2532801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker