| Doctor Name: | MRS. THERESA LORRAINE GIBBS |
| NPI Number: | 1770842676 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 138 North Court St Veteran's Memorial Building, 2nd Floor Wampsville, NY - 13163 |
| Business Phone Number: | 3153662327 |
| Business Fax Number: | 3153662599 |
| Mailing Address: | 7760 Myers Rd, KIRKVILLE |
| State: | NY |
| Postal Code: | 130829779 |
| Phone Number: | 3156562574 |
| Fax Number: | |
| NPI Enumeration Date: | 05/11/2012 |
| NPI Last Update Date: | 05/11/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |