Provider Demographics
NPI:1407027972
Name:GIPSON, TAHRIA MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:TAHRIA
Middle Name:MARIE
Last Name:GIPSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9503 PLUM LAKE LN W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32222-1573
Mailing Address - Country:US
Mailing Address - Phone:240-421-9057
Mailing Address - Fax:
Practice Address - Street 1:9503 PLUM LAKE LN W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32222-1573
Practice Address - Country:US
Practice Address - Phone:240-421-9057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-12
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL98511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical