Provider Demographics
NPI:1831740083
Name:GIBBS, CHRISTOPHER D (LCDC III)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:D
Last Name:GIBBS
Suffix:
Gender:M
Credentials:LCDC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 CASTLEGATE LN UNIT 103
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-7008
Mailing Address - Country:US
Mailing Address - Phone:513-348-6937
Mailing Address - Fax:
Practice Address - Street 1:1617 READING RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-1413
Practice Address - Country:US
Practice Address - Phone:513-629-2300
Practice Address - Fax:513-629-2311
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLCDCIII.161934101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)