| Doctor Name: | JACQUELINE M GIBSON |
| NPI Number: | 1144216615 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMHC |
| License Number: | MH4668 |
| Business Practice Address: | 3686 Us Highway 331 S Defuniak Springs, FL - 324358463 |
| Business Phone Number: | 8508928045 |
| Business Fax Number: | 8508928039 |
| Mailing Address: | 73 Dune Drive, SANTA ROSA BEACH |
| State: | FL |
| Postal Code: | 32548 |
| Phone Number: | 8502672001 |
| Fax Number: | |
| NPI Enumeration Date: | 09/21/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | MH4668 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |