Provider Demographics
NPI:1669545950
Name:GILBERT, KONSTANTINA MATHEOS (LPC, LPCC, LPAT)
Entity type:Individual
Prefix:MRS
First Name:KONSTANTINA
Middle Name:MATHEOS
Last Name:GILBERT
Suffix:
Gender:F
Credentials:LPC, LPCC, LPAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 TOWNE CENTER BLVD
Mailing Address - Street 2:SUITE 1300
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-4863
Mailing Address - Country:US
Mailing Address - Phone:601-977-9353
Mailing Address - Fax:
Practice Address - Street 1:361 TOWNE CENTER BLVD
Practice Address - Street 2:SUITE 1300
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4863
Practice Address - Country:US
Practice Address - Phone:601-977-9353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0074581101YM0800X
NM0090871101YM0800X
MS1223101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional