Provider Demographics
NPI:1801543491
Name:GIBSON, AMARIS
Entity type:Individual
Prefix:
First Name:AMARIS
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SALUDA
Mailing Address - State:SC
Mailing Address - Zip Code:29138-7343
Mailing Address - Country:US
Mailing Address - Phone:864-901-8845
Mailing Address - Fax:864-406-6042
Practice Address - Street 1:126 BROADBENT WAY
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29625-1520
Practice Address - Country:US
Practice Address - Phone:864-406-6041
Practice Address - Fax:864-406-6042
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7941101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional