Provider Demographics
NPI:1497108328
Name:HIBBERT, TAMIKA (EDD, LPC , NCC)
Entity Type:Individual
Prefix:DR
First Name:TAMIKA
Middle Name:
Last Name:HIBBERT
Suffix:
Gender:F
Credentials:EDD, LPC , NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 REGENTS WAY
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-3390
Mailing Address - Country:US
Mailing Address - Phone:347-885-2340
Mailing Address - Fax:
Practice Address - Street 1:1825 REGENTS WAY
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-3390
Practice Address - Country:US
Practice Address - Phone:347-885-2340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008642101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional