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General NPI Number Information
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NPI Number | 1669265559
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Entity Type | Individual
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Provider Name | JESSICA MIRANDA HIBBS BCBA, LBA
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Gender | Female
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Dates
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Enumeration Date | 05/23/2025
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 1622 TIMBERWOOD BLVD STE 112
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22911-7545
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Country | US
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Telephone | 434-200-8510
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Fax |
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Provider Business Mailing Address
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Address Line | 4218 DUSTY RD
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City | BARBOURSVILLE
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State | VA
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Zip | 22923-2014
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Country | US
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Telephone | 757-968-7733
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Fax |
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 0133004678
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License Number State | VA
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