Provider Demographics
NPI:1841409968
Name:GIBSON, CRON A (LMFT)
Entity Type:Individual
Prefix:MR
First Name:CRON
Middle Name:A
Last Name:GIBSON
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2008 BRETON CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-2211
Mailing Address - Country:US
Mailing Address - Phone:757-333-1548
Mailing Address - Fax:
Practice Address - Street 1:2008 BRETON CT
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2211
Practice Address - Country:US
Practice Address - Phone:757-333-1548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF 0500012106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist