Provider Demographics
NPI:1255099594
Name:BIBB, AKBAR MARVIN
Entity type:Individual
Prefix:
First Name:AKBAR
Middle Name:MARVIN
Last Name:BIBB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 198
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-0198
Mailing Address - Country:US
Mailing Address - Phone:916-505-8562
Mailing Address - Fax:
Practice Address - Street 1:4113 FALL CREEK COURT
Practice Address - Street 2:FAIRFIELD
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534
Practice Address - Country:US
Practice Address - Phone:707-863-0125
Practice Address - Fax:707-638-0398
Is Sole Proprietor?:No
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96544101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health