Provider Demographics
NPI:1225763931
Name:GIBSON, PATRICIA L (LPC)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:L
Last Name:GIBSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 MOORESTOWN CIR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-2733
Mailing Address - Country:US
Mailing Address - Phone:404-375-7943
Mailing Address - Fax:
Practice Address - Street 1:1114 MOORESTOWN CIR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-2733
Practice Address - Country:US
Practice Address - Phone:404-375-7943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC002958101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional