Provider Demographics
NPI:1669265559
Name:HIBBS, JESSICA MIRANDA (RBT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MIRANDA
Last Name:HIBBS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:MIRANDA
Other - Last Name:WORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4218 DUSTY RD
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22923-2014
Mailing Address - Country:US
Mailing Address - Phone:757-968-7733
Mailing Address - Fax:
Practice Address - Street 1:1622 TIMBERWOOD BLVD STE 112
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-7545
Practice Address - Country:US
Practice Address - Phone:434-200-8510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-20-136936106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician