Provider Demographics
NPI:1336338599
Name:BIBBS, ANTONICE S (LCSW)
Entity Type:Individual
Prefix:
First Name:ANTONICE
Middle Name:S
Last Name:BIBBS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 E CENTRAL TEXAS EXPY STE 301
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76541-9147
Mailing Address - Country:US
Mailing Address - Phone:254-458-2353
Mailing Address - Fax:254-853-4177
Practice Address - Street 1:1711 E CENTRAL TEXAS EXPY
Practice Address - Street 2:SUITE 301
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-9166
Practice Address - Country:US
Practice Address - Phone:254-458-2353
Practice Address - Fax:254-853-4177
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010878931041C0700X
171M00000X
TX584711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty