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General NPI Number Information
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NPI Number | 1710565429
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Entity Type | Individual
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Provider Name | ZACKERY J GIBBS
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Gender | Male
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Dates
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Enumeration Date | 04/01/2021
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Last Update Date | 07/22/2021
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Provider Practice Location Address
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Address Line | 1724 S 3RD ST
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City | IRONTON
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State | OH
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Zip | 45638-2269
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Country | US
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Telephone | 740-479-5135
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Fax | 740-237-4870
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Provider Business Mailing Address
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Address Line | 901 POWELL LN APT 5
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City | FLATWOODS
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State | KY
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Zip | 41139-1643
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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 | 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 #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 | CDCA.177308
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License Number State | OH
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