Provider Demographics
NPI:1558675082
Name:GIBSON, G. AKUA (LMSW)
Entity Type:Individual
Prefix:MS
First Name:G.
Middle Name:AKUA
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 1:23 OLYMPIAN DR
Mailing Address - Street 2:
Mailing Address - City:SLINGERLANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12159-9638
Mailing Address - Country:US
Mailing Address - Phone:518-459-2973
Mailing Address - Fax:518-320-8357
Practice Address - Street 1:23 OLYMPIAN DR
Practice Address - Street 2:
Practice Address - City:SLINGERLANDS
Practice Address - State:NY
Practice Address - Zip Code:12159-9638
Practice Address - Country:US
Practice Address - Phone:518-459-2973
Practice Address - Fax:518-320-8357
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072048104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY072048OtherSOCIAL WORK LICENSE