Healthcare Provider Details

I. General information

NPI: 1306548540
Provider Name (Legal Business Name): CHRISTA DENISE GIBSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3411 OFFICE PARK DR
DAYTON OH
45439-2298
US

IV. Provider business mailing address

1628 SPRINGFIELD ST
DAYTON OH
45403-1430
US

V. Phone/Fax

Practice location:
  • Phone: 937-802-5440
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: