Provider Demographics
NPI:1982172391
Name:GIBSON, BRANDI (MED, LCMHC, NCC)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MED, LCMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4005 QUARRY RD
Mailing Address - Street 2:
Mailing Address - City:ZEBULON
Mailing Address - State:NC
Mailing Address - Zip Code:27597-8788
Mailing Address - Country:US
Mailing Address - Phone:919-971-4064
Mailing Address - Fax:
Practice Address - Street 1:4005 QUARRY RD
Practice Address - Street 2:
Practice Address - City:ZEBULON
Practice Address - State:NC
Practice Address - Zip Code:27597-8788
Practice Address - Country:US
Practice Address - Phone:919-971-4064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14408101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health