Provider Demographics
NPI:1326322728
Name:GIBSON, ELVETA E (LICSW, LCSW-C, LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELVETA
Middle Name:E
Last Name:GIBSON
Suffix:
Gender:F
Credentials:LICSW, LCSW-C, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 POST OFFICE RD STE 301
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-1913
Mailing Address - Country:US
Mailing Address - Phone:301-609-2988
Mailing Address - Fax:240-427-9250
Practice Address - Street 1:605 POST OFFICE RD STE 301
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-1913
Practice Address - Country:US
Practice Address - Phone:301-609-2988
Practice Address - Fax:240-427-9250
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-04
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD136051041C0700X
VA09040118171041C0700X
DCLC500784091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical