Healthcare Provider Details

I. General information

NPI: 1598676793
Provider Name (Legal Business Name): MATTHEW TRENTON GIBSON BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 TREASURE TRL
GREENSBORO NC
27455-9327
US

IV. Provider business mailing address

308 TREASURE TRL
GREENSBORO NC
27455-9327
US

V. Phone/Fax

Practice location:
  • Phone: 434-548-5469
  • Fax:
Mailing address:
  • Phone: 434-548-5469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2850556
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: