MEDICARE: MS. LETERRICA GIBBS PHD.

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	101Y00000X	Counselor	05767	AL

General Provider Information

NPI Number	:	1417783952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LETERRICA GIBBS PHD.

Provider Business Mailing Address
First Line	:	8996 ABINGDON PL
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-8453
Country	:	US
Telephone Number	:	334-868-9313
Fax Number	:

Provider Business Practice Location Address
First Line	:	1406 I85 PKWY
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36106-2813
Country	:	US
Telephone Number	:	334-868-9313
Fax Number	:

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

Provider Enumeration Date	:	09/11/2024
Last Update Date	:	12/23/2025

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