MEDICARE: ANEYA GIBBS MSW,LCSWS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	8051317	NC

General Provider Information

NPI Number	:	1053844100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANEYA GIBBS MSW,LCSWS

Provider Business Mailing Address
First Line	:	212 ACORN FALLS CT
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-5906
Country	:	US
Telephone Number	:	919-480-7109
Fax Number	:	919-954-7363

Provider Business Practice Location Address
First Line	:	212 ACORN FALLS CT
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-5906
Country	:	US
Telephone Number	:	919-480-7109
Fax Number	:	919-954-7363

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2017
Last Update Date	:	04/05/2017

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