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General NPI Number Information
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NPI Number | 1326322728
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Entity Type | Individual
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Provider Name | ELVETA E. GIBSON LICSW, LCSW-C, LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/04/2011
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Last Update Date | 11/23/2021
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Provider Practice Location Address
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Address Line | 605 POST OFFICE RD STE 301
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City | WALDORF
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State | MD
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Zip | 20602-1913
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Country | US
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Telephone | 301-609-2988
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Fax | 240-427-9250
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Provider Business Mailing Address
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Address Line | 605 POST OFFICE RD STE 301
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City | WALDORF
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State | MD
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Zip | 20602-1913
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Country | US
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Telephone | 301-609-2988
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Fax | 240-427-9250
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 13605
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904011817
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC50078409
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License Number State | DC
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