Provider Demographics
NPI:1336486950
Name:THATCH, CARLA BIBBY
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:BIBBY
Last Name:THATCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4907 CHASTE TREE PL
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-5440
Mailing Address - Country:US
Mailing Address - Phone:216-269-6314
Mailing Address - Fax:571-295-3205
Practice Address - Street 1:309 MILL ST
Practice Address - Street 2:#101
Practice Address - City:OCCOQUAN
Practice Address - State:VA
Practice Address - Zip Code:22125
Practice Address - Country:US
Practice Address - Phone:703-494-3949
Practice Address - Fax:571-295-3205
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator