Provider Demographics
NPI:1578814182
Name:GIBBS, ALPHONSO JR (LCSW-C)
Entity Type:Individual
Prefix:MR
First Name:ALPHONSO
Middle Name:
Last Name:GIBBS
Suffix:JR
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5855 VALLEY DR UNIT 1054
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-3630
Mailing Address - Country:US
Mailing Address - Phone:443-804-6158
Mailing Address - Fax:
Practice Address - Street 1:5855 VALLEY DR UNIT 1054
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-3630
Practice Address - Country:US
Practice Address - Phone:443-804-6158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-21
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD184421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical