Active NPI
Michelle A Pettis-Tibbs, LCSW
- Clinical Social Worker
- Salem, VA
National Provider Identifier
1912964776
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 434-970-3400
- Practice address
- 1970 Roanoke Blvd
4730-B Sussex CT
Salem, VA 24153-6404 - Phone
- (540) 982-2463
- NPI assigned
- Apr 27, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 434-970-3400 | VA | Primary |
Addresses
Primary practice location
1970 Roanoke Blvd
4730-B Sussex CT
Salem, VA 24153-6404
Mailing address
1970 Roanoke Blvd
1970 Roanoke Blvd
Salem, VA 24153-6404
Phone (540) 982-2463
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 434-970-3400 | VA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146096000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1397001600000",
"number": "1912964776",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1970 ROANOKE BLVD",
"address_2": "1970 ROANOKE BLVD",
"city": "SALEM",
"state": "VA",
"postal_code": "241536404",
"telephone_number": "540-982-2463",
"fax_number": "540-224-1932"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1970 ROANOKE BLVD",
"address_2": "4730-B SUSSEX CT",
"city": "SALEM",
"state": "VA",
"postal_code": "241536404",
"telephone_number": "540-982-2463"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTIS-TIBBS",
"first_name": "MICHELLE",
"middle_name": "A",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-04-27",
"last_updated": "2014-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "VA",
"license": "434-970-3400",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salem, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.