Provider Demographics
NPI:1689898017
Name:GIBSON, WANDA MAE (BSW)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:MAE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2177 ASHEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-3139
Mailing Address - Country:US
Mailing Address - Phone:828-452-6675
Mailing Address - Fax:828-452-6730
Practice Address - Street 1:HAYWOOD COUNTY HEALTH DEPARTMENT
Practice Address - Street 2:2177 ASHEVILLE RD.
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-3139
Practice Address - Country:US
Practice Address - Phone:828-452-6675
Practice Address - Fax:828-452-6730
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker