Healthcare Provider Details

I. General information

NPI: 1609362490
Provider Name (Legal Business Name): CHERYL K. GIBSON LPCA, LCADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 01/21/2023
Certification Date: 01/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 TOWN BRANCH RD STE 2
MANCHESTER KY
40962-1326
US

IV. Provider business mailing address

86 HIGHWAY 638 STE 1
MANCHESTER KY
40962-7289
US

V. Phone/Fax

Practice location:
  • Phone: 606-598-0070
  • Fax: 844-273-1765
Mailing address:
  • Phone: 606-598-0070
  • Fax: 844-273-1765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number248391
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number242173
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: