Individual
LEROY BIBBS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MASTER'S DEGREE HUMA
Contact information
Practice address
203 LONG RIDGE DR, COLUMBIA, SC 29229-9284
(215) 266-8158
Mailing address
203 LONG RIDGE DR, COLUMBIA, SC 29229-9284
(215) 266-8158
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
27-0843094
PA
Other
Enumeration date
04/02/2021
Last updated
04/02/2021
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