Provider Demographics
NPI:1265835789
Name:GIBBS, GINGER THERESA (MA)
Entity Type:Individual
Prefix:MS
First Name:GINGER
Middle Name:THERESA
Last Name:GIBBS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:GINGER
Other - Middle Name:THERESA
Other - Last Name:BARKSDALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:45 E CITY AVE # 324
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-2421
Mailing Address - Country:US
Mailing Address - Phone:267-235-1598
Mailing Address - Fax:
Practice Address - Street 1:45 E CITY AVE # 324
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-2421
Practice Address - Country:US
Practice Address - Phone:267-235-1598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH002210101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health