Provider Demographics
NPI:1093317943
Name:GIBBONS, CASSIE LYNN (PHD, ALC, NCC)
Entity Type:Individual
Prefix:DR
First Name:CASSIE
Middle Name:LYNN
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:PHD, ALC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 WILLIAM WAY PL SE
Mailing Address - Street 2:
Mailing Address - City:GURLEY
Mailing Address - State:AL
Mailing Address - Zip Code:35748-8032
Mailing Address - Country:US
Mailing Address - Phone:719-205-0755
Mailing Address - Fax:
Practice Address - Street 1:220 RHETT AVE SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4552
Practice Address - Country:US
Practice Address - Phone:256-517-3330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-14
Last Update Date:2020-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC3557A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC3557AOtherALABAMA BOARD OF EXAMINERS IN COUNSELING