Healthcare Provider Details

I. General information

NPI: 1104459239
Provider Name (Legal Business Name): NATALIE GIBSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

977 ENOTA AVE NE
GAINESVILLE GA
30501-1700
US

IV. Provider business mailing address

977 ENOTA AVE NE
GAINESVILLE GA
30501-1700
US

V. Phone/Fax

Practice location:
  • Phone: 470-290-8363
  • Fax: 352-504-0923
Mailing address:
  • Phone: 470-290-8363
  • Fax: 352-504-0923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC009815
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: