Provider Demographics
NPI:1033279187
Name:GIBSON, RAGINA MISHELLE (MFTI)
Entity Type:Individual
Prefix:
First Name:RAGINA
Middle Name:MISHELLE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1899 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-3501
Mailing Address - Country:US
Mailing Address - Phone:415-934-3440
Mailing Address - Fax:415-626-9263
Practice Address - Street 1:1899 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-3501
Practice Address - Country:US
Practice Address - Phone:415-934-3440
Practice Address - Fax:415-626-9263
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50663106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist