Provider Demographics
NPI:1811775588
Name:CHRISTIAN GIBBONS, HOLLY JEAN (MA, LMHC)
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:JEAN
Last Name:CHRISTIAN GIBBONS
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1536 SUNRISE PLAZA DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34714-6204
Mailing Address - Country:US
Mailing Address - Phone:407-488-4892
Mailing Address - Fax:
Practice Address - Street 1:1536 SUNRISE PLAZA DR STE 100
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34714-6204
Practice Address - Country:US
Practice Address - Phone:407-488-4892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22751101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health