Provider Demographics
NPI:1447305511
Name:BIBB, SUZANNE S (LCSW)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:S
Last Name:BIBB
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E BLOUNT AVE
Mailing Address - Street 2:BAPTIST MEDICAL TOWER SUITE 650
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1601
Mailing Address - Country:US
Mailing Address - Phone:865-632-5058
Mailing Address - Fax:
Practice Address - Street 1:101 E BLOUNT AVE
Practice Address - Street 2:BAPTIST MEDICAL TOWER SUITE 650
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1632
Practice Address - Country:US
Practice Address - Phone:865-632-5058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN036911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN03691OtherSTATE LICENSE