Provider Demographics
NPI:1912043779
Name:GIBSON, STEPHANIE C (LPC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:C
Last Name:GIBSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:938 SQUIRREL RUN RD
Mailing Address - Street 2:
Mailing Address - City:HEMINGWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29554-4855
Mailing Address - Country:US
Mailing Address - Phone:843-558-5229
Mailing Address - Fax:
Practice Address - Street 1:525 LAFAYETTE CIR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-2569
Practice Address - Country:US
Practice Address - Phone:843-546-6107
Practice Address - Fax:843-527-2800
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health