Provider Demographics
NPI:1558591032
Name:GIBSON, RITA ZONIA (LMSW)
Entity Type:Individual
Prefix:MS
First Name:RITA
Middle Name:ZONIA
Last Name:GIBSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 E 7 MILE RD
Mailing Address - Street 2:NORTHEAST HEALTH CENTER
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-2461
Mailing Address - Country:US
Mailing Address - Phone:313-870-3054
Mailing Address - Fax:
Practice Address - Street 1:5400 E 7 MILE RD
Practice Address - Street 2:NORTHEAST HEALTH CENTER
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-2461
Practice Address - Country:US
Practice Address - Phone:313-870-3054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801083805104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical