Healthcare Provider Details

I. General information

NPI: 1245914019
Provider Name (Legal Business Name): SHERRY ANNETTE GIBBONS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. SHERRY ANNETTE DANYEUR

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 W JEFFERSON ST
CRESCENT CITY CA
95531-8370
US

IV. Provider business mailing address

275 W JEFFERSON ST
CRESCENT CITY CA
95531-8370
US

V. Phone/Fax

Practice location:
  • Phone: 707-951-7451
  • Fax:
Mailing address:
  • Phone: 707-951-7451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number138027
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: