Provider Demographics
NPI:1932138344
Name:GIBSON, GEORGEANNA (LPCC)
Entity Type:Individual
Prefix:
First Name:GEORGEANNA
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9940 ALVATON RD
Mailing Address - Street 2:
Mailing Address - City:ALVATON
Mailing Address - State:KY
Mailing Address - Zip Code:42122-9657
Mailing Address - Country:US
Mailing Address - Phone:270-746-6600
Mailing Address - Fax:270-842-9008
Practice Address - Street 1:1621 SCOTTSVILLE RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3244
Practice Address - Country:US
Practice Address - Phone:270-746-6600
Practice Address - Fax:270-842-9008
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY104885101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100274700Medicaid