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General NPI Number Information
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NPI Number | 1336338599
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Entity Type | Individual
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Provider Name | ANTONICE S BIBBS LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/23/2007
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Last Update Date | 03/27/2019
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Provider Practice Location Address
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Address Line | 1711 E CENTRAL TEXAS EXPY SUITE 301
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City | KILLEEN
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State | TX
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Zip | 76541-9166
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Country | US
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Telephone | 254-458-2353
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Fax | 254-853-4177
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Provider Business Mailing Address
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Address Line | 1711 E CENTRAL TEXAS EXPY STE 301
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City | KILLEEN
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State | TX
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Zip | 76541-9147
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Country | US
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Telephone | 254-458-2353
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Fax | 254-853-4177
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801087893
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 58471
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License Number State | TX
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