Provider Demographics
NPI:1164964615
Name:GIBSON, BOBBY JR (MS)
Entity Type:Individual
Prefix:
First Name:BOBBY
Middle Name:
Last Name:GIBSON
Suffix:JR
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 W CLAIBORNE ST
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36460-1738
Mailing Address - Country:US
Mailing Address - Phone:251-575-4203
Mailing Address - Fax:251-575-9459
Practice Address - Street 1:328 W CLAIBORNE ST
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36460-1738
Practice Address - Country:US
Practice Address - Phone:251-575-4203
Practice Address - Fax:251-575-9459
Is Sole Proprietor?:No
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)