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General NPI Number Information
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NPI Number | 1265782767
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Entity Type | Individual
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Provider Name | TAMEKA SPROLING GIBSON MA, LPC , CRC, LADAC
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Gender | Female
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Dates
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Enumeration Date | 09/12/2012
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Last Update Date | 09/24/2015
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Provider Practice Location Address
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Address Line | 10 CORPORATE HILL DR 330
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City | LITTLE ROCK
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State | AR
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Zip | 72205-4540
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Country | US
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Telephone | 501-954-7470
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Fax | 501-954-7420
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Provider Business Mailing Address
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Address Line | 10 CORPORATE HILL DR 330
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City | LITTLE ROCK
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State | AR
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Zip | 72205-4540
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Country | US
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Telephone | 501-954-7470
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Fax | 501-954-7420
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | P1408060
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 225C00000X
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Taxonomy Name | Rehabilitation Counselor
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License Number | 00114996
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 327L
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License Number State | AR
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