Provider Demographics
NPI:1609473404
Name:GIBSON, SOLENA MARIE (LISW-S)
Entity Type:Individual
Prefix:
First Name:SOLENA
Middle Name:MARIE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3271 GROVEPARK DR
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-4805
Mailing Address - Country:US
Mailing Address - Phone:614-753-7421
Mailing Address - Fax:
Practice Address - Street 1:27070 CEDAR RD
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-8131
Practice Address - Country:US
Practice Address - Phone:216-831-2881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1801077-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical