Healthcare Provider Details

I. General information

NPI: 1013786102
Provider Name (Legal Business Name): SUMMER LEIGH TIBBS CDCA, QMHS HS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2023
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1819 WOOD ST
WHEELING WV
26003-3607
US

IV. Provider business mailing address

50388 STATE ROUTE 556
CLARINGTON OH
43915-9608
US

V. Phone/Fax

Practice location:
  • Phone: 304-234-3583
  • Fax:
Mailing address:
  • Phone: 740-213-5943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: