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NPI Code Detail

MEDICARE: MR. ALEX J GIBSON PSYD

MEDICARE: MR. ALEX J GIBSON PSYD
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
1103TC0700XClinical Psychologist0810007662VA

General Provider Information

NPI Number : 1902353360
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ALEX J GIBSON PSYD
Provider Business Mailing Address
First Line : 107 CARPENTER DRIVE
Second Line : SUITE 210
City : STERLING
State : VA
Zip : 20164-4468
Country : US
Telephone Number : 703-297-4368
Fax Number : 571-512-7955
Provider Business Practice Location Address
First Line : 107 CARPENTER DRIVE
Second Line : SUITE 210
City : STERLING
State : VA
Zip : 20164-4468
Country : US
Telephone Number : 703-297-4368
Fax Number : 571-512-7955
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2016
Last Update Date : 01/16/2026

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