Provider Demographics
NPI:1770240202
Name:GIBSON, ROSELINE D (LCSWA)
Entity Type:Individual
Prefix:
First Name:ROSELINE
Middle Name:D
Last Name:GIBSON
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7509 CREEKRIDGE RD APT 201
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-1007
Mailing Address - Country:US
Mailing Address - Phone:910-852-3024
Mailing Address - Fax:
Practice Address - Street 1:7509 CREEKRIDGE RD APT 201
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-1007
Practice Address - Country:US
Practice Address - Phone:910-852-3024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical