Provider Demographics
NPI:1336646314
Name:GIBSON, DOROTHY (RBT)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8454B WRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:FORT CAMPBELL
Mailing Address - State:KY
Mailing Address - Zip Code:42223-3843
Mailing Address - Country:US
Mailing Address - Phone:567-868-2031
Mailing Address - Fax:
Practice Address - Street 1:220 GREAT CIRCLE RD STE 124
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37228-1705
Practice Address - Country:US
Practice Address - Phone:615-331-1141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician