Doctor Name: | GINAVRA GIBSON |
NPI Number: | 1811372667 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 119a Malibu Dr Batesburg, SC - 290062121 |
Business Phone Number: | 8035328414 |
Business Fax Number: | 8035324570 |
Mailing Address: | 301 Palmetto Park Blvd, LEXINGTON |
State: | SC |
Postal Code: | 290727872 |
Phone Number: | 8033593545 |
Fax Number: | 8033592111 |
NPI Enumeration Date: | 07/22/2015 |
NPI Last Update Date: | 07/22/2015 |
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: |