Provider Demographics
NPI:1942760848
Name:GIBBS, MONICA CAMILLA
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:CAMILLA
Last Name:GIBBS
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 1:1604 WEBSTER ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-4210
Mailing Address - Country:US
Mailing Address - Phone:202-723-6391
Mailing Address - Fax:
Practice Address - Street 1:1604 WEBSTER ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-4210
Practice Address - Country:US
Practice Address - Phone:202-723-6391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC103TH0100X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service