Provider Demographics
NPI:1851075022
Name:TIBREWALA, AYUSHI
Entity Type:Individual
Prefix:
First Name:AYUSHI
Middle Name:
Last Name:TIBREWALA
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 1:8403 COLESVILLE RD STE 1100
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-6346
Mailing Address - Country:US
Mailing Address - Phone:628-758-8237
Mailing Address - Fax:
Practice Address - Street 1:8403 COLESVILLE RD STE 1100
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-6346
Practice Address - Country:US
Practice Address - Phone:202-964-3957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-09
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP13925101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional