Provider Demographics
NPI:1336293349
Name:GIBSON, BARBARA (LPA)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 RAEFORD RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5294
Mailing Address - Country:US
Mailing Address - Phone:910-624-3367
Mailing Address - Fax:910-485-2431
Practice Address - Street 1:2504 RAEFORD RD
Practice Address - Street 2:SUITE 110
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5294
Practice Address - Country:US
Practice Address - Phone:910-624-3367
Practice Address - Fax:910-485-2431
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1859103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107257Medicaid