Provider Demographics
NPI:1275638496
Name:GIBBS, BOBBY JOE (BA,, FADOP)
Entity Type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:JOE
Last Name:GIBBS
Suffix:
Gender:M
Credentials:BA,, FADOP
Other - Prefix:
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Mailing Address - Street 1:2354 HARVEY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48356-2129
Mailing Address - Country:US
Mailing Address - Phone:248-406-0900
Mailing Address - Fax:248-666-8822
Practice Address - Street 1:1435 N OAKLAND BLVD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1549
Practice Address - Country:US
Practice Address - Phone:248-666-2720
Practice Address - Fax:246-666-8822
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)