Provider Demographics
NPI:1922121193
Name:FIBBE, THOMAS RAY (LPC)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:RAY
Last Name:FIBBE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 BERKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:FORT VALLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31030-3576
Mailing Address - Country:US
Mailing Address - Phone:478-825-7221
Mailing Address - Fax:478-825-7221
Practice Address - Street 1:239 BERKSHIRE DR
Practice Address - Street 2:
Practice Address - City:FORT VALLEY
Practice Address - State:GA
Practice Address - Zip Code:31030-3576
Practice Address - Country:US
Practice Address - Phone:478-825-7221
Practice Address - Fax:478-825-7221
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC001198101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional