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General NPI Number Information
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NPI Number | 1174030654
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Entity Type | Individual
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Provider Name | ANTHONY GIBSON
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Gender | Male
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Dates
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Enumeration Date | 01/05/2018
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Last Update Date | 11/07/2023
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Provider Practice Location Address
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Address Line | 1920 S 9TH ST
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City | IRONTON
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State | OH
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Zip | 45638
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Country | US
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Telephone | 740-479-5120
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 396
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City | SPRINGBORO
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State | OH
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Zip | 45066-0396
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | S.2207357
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LICDC.162494
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License Number State | OH
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