Provider Demographics
NPI:1467503524
Name:HIBBERT, THOMAS A (MA)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:HIBBERT
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 WELLSTONE CIR
Mailing Address - Street 2:P O BOX 1257
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-3257
Mailing Address - Country:US
Mailing Address - Phone:919-387-5948
Mailing Address - Fax:919-387-7649
Practice Address - Street 1:665 TIMBER TRAIL
Practice Address - Street 2:
Practice Address - City:GOLD HILL
Practice Address - State:NC
Practice Address - Zip Code:28071
Practice Address - Country:US
Practice Address - Phone:704-279-1199
Practice Address - Fax:704-279-7668
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1609852201OtherFACILITY NPI NUMBER
NC6603028Medicaid