Provider Demographics
NPI:1861935348
Name:SHIBLEY, VERONICA
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:SHIBLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3288 ADAMS AVE UNIT 161339
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92176-7055
Mailing Address - Country:US
Mailing Address - Phone:831-402-9197
Mailing Address - Fax:
Practice Address - Street 1:1203 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6419
Practice Address - Country:US
Practice Address - Phone:740-223-8809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74156104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker