Provider Demographics
NPI:1811378300
Name:LEBBIE, TIERRA (M ED)
Entity Type:Individual
Prefix:
First Name:TIERRA
Middle Name:
Last Name:LEBBIE
Suffix:
Gender:M
Credentials:M ED
Other - Prefix:
Other - First Name:TIERRA
Other - Middle Name:LATRICE
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1500 DECEMBER DR APT 304
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-3611
Mailing Address - Country:US
Mailing Address - Phone:252-259-5829
Mailing Address - Fax:
Practice Address - Street 1:1500 DECEMBER DR APT 304
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-3611
Practice Address - Country:US
Practice Address - Phone:252-259-5829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07853235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist