Provider Demographics
NPI:1952432056
Name:GIBBS, CRAIG WILLIAM (LCSW)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:WILLIAM
Last Name:GIBBS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 HIGH ST
Mailing Address - Street 2:SUITE 120A
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-5043
Mailing Address - Country:US
Mailing Address - Phone:530-878-8319
Mailing Address - Fax:
Practice Address - Street 1:1230 HIGH ST
Practice Address - Street 2:SUITE 120A
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-5043
Practice Address - Country:US
Practice Address - Phone:530-878-8319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27635101YM0800X, 1041C0700X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA27635OtherLCSW