| Doctor Name: | MRS. SUSANN RENEE LIGHT-GIBSON |
| NPI Number: | 1649315300 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MED, CSAC |
| License Number: | 0710102161 |
| Business Practice Address: | 3169 2nd Ave E Big Stone Gap, VA - 242193805 |
| Business Phone Number: | 2765238300 |
| Business Fax Number: | 2765236964 |
| Mailing Address: | Po Box 9054, GRAY |
| State: | TN |
| Postal Code: | 376159054 |
| Phone Number: | 4234673600 |
| Fax Number: | 4234673644 |
| NPI Enumeration Date: | 02/21/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | 0710102161 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |