Provider Demographics
NPI:1710690482
Name:GIBBS, REGINALD (LPC LICENSE)
Entity Type:Individual
Prefix:
First Name:REGINALD
Middle Name:
Last Name:GIBBS
Suffix:
Gender:M
Credentials:LPC LICENSE
Other - Prefix:MISS
Other - First Name:LATISHA
Other - Middle Name:
Other - Last Name:DAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:150 PATTERSON ST
Mailing Address - Street 2:
Mailing Address - City:ATMORE
Mailing Address - State:AL
Mailing Address - Zip Code:36502-1818
Mailing Address - Country:US
Mailing Address - Phone:251-359-6459
Mailing Address - Fax:
Practice Address - Street 1:150 PATTERSON ST
Practice Address - Street 2:
Practice Address - City:ATMORE
Practice Address - State:AL
Practice Address - Zip Code:36502-1818
Practice Address - Country:US
Practice Address - Phone:251-359-6459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALRSE1138106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst