MEDICARE: REBECA GIBBONS LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LPC012856	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073927430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECA GIBBONS LPC

Provider Business Mailing Address
First Line	:	2866 STANTON RD SE
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30094-2652
Country	:	US
Telephone Number	:	404-438-9978
Fax Number	:

Provider Business Practice Location Address
First Line	:	2866 STANTON RD SE
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30094-2652
Country	:	US
Telephone Number	:	404-438-9978
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2014
Last Update Date	:	04/09/2026

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