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General NPI Number Information
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NPI Number | 1942951850
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Entity Type | Individual
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Provider Name | KATHLEEN JOYCE GIBSON LCMHCA
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Gender | Female
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Dates
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Enumeration Date | 01/12/2022
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Last Update Date | 01/12/2022
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Provider Practice Location Address
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Address Line | 1437 MILITARY CUTOFF RD STE 200
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City | WILMINGTON
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State | NC
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Zip | 28403-3638
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Country | US
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Telephone | 910-240-3392
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Fax | 910-447-4421
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Provider Business Mailing Address
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Address Line | 1655 CHADWICK SHORES DR
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City | SNEADS FERRY
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State | NC
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Zip | 28460-9281
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Country | US
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Telephone | 540-850-6242
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | A17191
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number | A17191
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A17191
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License Number State | NC
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