Provider Demographics
NPI:1427438662
Name:GIBBONS, DENISE EVA (LMHC, MCAP)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:EVA
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:LMHC, MCAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9469 TREASURE LN NE
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2666
Mailing Address - Country:US
Mailing Address - Phone:727-480-2068
Mailing Address - Fax:
Practice Address - Street 1:9469 TREASURE LN NE
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-2666
Practice Address - Country:US
Practice Address - Phone:727-502-0188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-03
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9352101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health