Healthcare Provider Details

I. General information

NPI: 1497227029
Provider Name (Legal Business Name): JAMES GIBBONS CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2018
Last Update Date: 12/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 CEDAR ST
MUSCATINE IA
52761-3426
US

IV. Provider business mailing address

1605 CEDAR ST
MUSCATINE IA
52761-3426
US

V. Phone/Fax

Practice location:
  • Phone: 563-264-9409
  • Fax: 563-264-9501
Mailing address:
  • Phone: 563-264-9409
  • Fax: 563-264-9501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: