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NPI Code Detail

MEDICARE: SALOME JOY TIBBS

MEDICARE:   SALOME JOY TIBBS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1679420491
Entity Type Code : Individual
Provider Name (Legal Business Name) : SALOME JOY TIBBS
Provider Business Mailing Address
First Line : 3450 BERKMAR DR
Second Line :
City : CHARLOTTESVILLE
State : VA
Zip : 22901-8052
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3450 BERKMAR DR
Second Line :
City : CHARLOTTESVILLE
State : VA
Zip : 22901-8052
Country : US
Telephone Number : 540-738-7720
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2026
Last Update Date : 03/11/2026

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Directions to “ SALOME JOY TIBBS ” Practice Location

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