Provider Demographics
NPI:1104459239
Name:GIBSON, NATALIE (LPC)
Entity type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 MOUNT SINAI DR
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-2367
Mailing Address - Country:US
Mailing Address - Phone:706-482-2040
Mailing Address - Fax:706-482-2059
Practice Address - Street 1:330 MOUNT SINAI DR
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-2367
Practice Address - Country:US
Practice Address - Phone:706-482-2040
Practice Address - Fax:706-482-2059
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009815101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional