Provider Demographics
NPI:1265288211
Name:GIBSON, ELIZABETH MARGARET (MHCI)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:MARGARET
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2782 GREEN BAY LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-4104
Mailing Address - Country:US
Mailing Address - Phone:904-377-9825
Mailing Address - Fax:
Practice Address - Street 1:3190 POST ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-6034
Practice Address - Country:US
Practice Address - Phone:904-735-9111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21570101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health