Provider Demographics
NPI:1437584810
Name:GIBBS, PAMELA MCGHEE (LPC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:MCGHEE
Last Name:GIBBS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1479 BROCKETT RD STE 100
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-7326
Mailing Address - Country:US
Mailing Address - Phone:770-375-8124
Mailing Address - Fax:770-559-5543
Practice Address - Street 1:1479 BROCKETT RD STE 100
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-7326
Practice Address - Country:US
Practice Address - Phone:770-375-8124
Practice Address - Fax:770-559-5543
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-04
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007079101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional