Provider Demographics
NPI:1629241484
Name:GIBSON, DANIEL (RAS)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:GIBSON
Suffix:
Gender:M
Credentials:RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 POST OFFICE DR. F
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003
Mailing Address - Country:US
Mailing Address - Phone:831-476-1747
Mailing Address - Fax:831-476-1362
Practice Address - Street 1:105 POST OFFICE DR.
Practice Address - Street 2:F
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003
Practice Address - Country:US
Practice Address - Phone:831-476-1747
Practice Address - Fax:831-476-1362
Is Sole Proprietor?:No
Enumeration Date:2008-04-11
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)