Provider Demographics
NPI:1346370673
Name:GIBSON, JAMES W III (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:W
Last Name:GIBSON
Suffix:III
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:JAMES
Other - Middle Name:W
Other - Last Name:GIBSON
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:3200 MOTOR AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-3710
Mailing Address - Country:US
Mailing Address - Phone:310-836-1223
Mailing Address - Fax:
Practice Address - Street 1:3200 MOTOR AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-3710
Practice Address - Country:US
Practice Address - Phone:310-836-1223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW215721041C0700X
CA215721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1346370673Medicaid