Provider Demographics
NPI:1558009035
Name:GIBBS, ANDRE DEXTER (LMFT)
Entity Type:Individual
Prefix:MR
First Name:ANDRE
Middle Name:DEXTER
Last Name:GIBBS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 WEBSTER CT
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-5125
Mailing Address - Country:US
Mailing Address - Phone:860-967-1464
Mailing Address - Fax:
Practice Address - Street 1:145 WEBSTER CT
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-5125
Practice Address - Country:US
Practice Address - Phone:860-967-1464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2806106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty