Provider Demographics
NPI:1447007596
Name:BIBB, LADANNA
Entity type:Individual
Prefix:
First Name:LADANNA
Middle Name:
Last Name:BIBB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18087 WESTPHALIA ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-2640
Mailing Address - Country:US
Mailing Address - Phone:586-447-6001
Mailing Address - Fax:
Practice Address - Street 1:18087 WESTPHALIA ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205-2640
Practice Address - Country:US
Practice Address - Phone:586-447-6001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service