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General NPI Number Information
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NPI Number | 1427691807
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Entity Type | Individual
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Provider Name | TRACY GIBSON LGSW, LMSW, LCSWA
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Gender | Female
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Dates
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Enumeration Date | 10/18/2019
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Last Update Date | 01/27/2020
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Provider Practice Location Address
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Address Line | 14969 SANTA LUCIA DR
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City | CHARLOTTE
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State | NC
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Zip | 28277-3382
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Country | US
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Telephone | 540-577-2400
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 473864
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City | CHARLOTTE
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State | NC
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Zip | 28247-3864
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Country | US
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Telephone | 704-412-1896
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 13362
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License Number State | SC
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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 | 4680G
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | P014226
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License Number State | NC
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