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General NPI Number Information
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NPI Number | 1245543453
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Entity Type | Individual
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Provider Name | BEVERLY M GIBSON LCADC, CSW
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Gender | Female
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Dates
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Enumeration Date | 07/16/2010
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Last Update Date | 07/16/2010
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Provider Practice Location Address
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Address Line | 68 DUNMORE AVNEUE
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City | EWING
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State | NJ
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Zip | 08618
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Country | US
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Telephone | 609-577-9714
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Fax | 608-671-1500
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Provider Business Mailing Address
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Address Line | 68 DUNMORE AVE
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City | EWING
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State | NJ
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Zip | 08618-1974
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Country | US
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Telephone | 609-577-9714
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Fax | 609-671-0015
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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 | 44SW00330700
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 37LC00032400
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License Number State | NJ
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