Healthcare Provider Details

I. General information

NPI: 1023377553
Provider Name (Legal Business Name): STEPHANIE GIBBS MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2012
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 SHELL DR APT 193
SPRING LAKE NC
28390-2073
US

IV. Provider business mailing address

921 SHELL DR APT 193
SPRING LAKE NC
28390-2073
US

V. Phone/Fax

Practice location:
  • Phone: 412-623-9550
  • Fax:
Mailing address:
  • Phone: 412-623-9550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMF001091
License Number StatePA

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: