Provider Demographics
NPI:1841621646
Name:HIBBARD THERAPY, LLC
Entity type:Organization
Organization Name:HIBBARD THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HIBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-245-2199
Mailing Address - Street 1:365 WILETT DR
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-1920
Mailing Address - Country:US
Mailing Address - Phone:410-245-2199
Mailing Address - Fax:410-544-4125
Practice Address - Street 1:507 WEST DR
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-2623
Practice Address - Country:US
Practice Address - Phone:410-245-2199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4701101YM0800X
MD132491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty