Provider Demographics
NPI:1750432506
Name:HIBBS, EUTHYMIA DOUVALETAS (PH,D)
Entity type:Individual
Prefix:DR
First Name:EUTHYMIA
Middle Name:DOUVALETAS
Last Name:HIBBS
Suffix:
Gender:F
Credentials:PH,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7302 DURBIN TER
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-6127
Mailing Address - Country:US
Mailing Address - Phone:301-652-5552
Mailing Address - Fax:301-654-7496
Practice Address - Street 1:7302 DURBIN TER
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-6127
Practice Address - Country:US
Practice Address - Phone:301-652-5552
Practice Address - Fax:301-654-7496
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02403103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDHI606837Medicare ID - Type UnspecifiedPROVIDER