Provider Demographics
NPI:1619345741
Name:GIBSON, JOEL HERMAN JR (LPC)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:HERMAN
Last Name:GIBSON
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 S MILLEDGE AVE STE 1A
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-1292
Mailing Address - Country:US
Mailing Address - Phone:706-498-9560
Mailing Address - Fax:706-498-9568
Practice Address - Street 1:745 S MILLEDGE AVE STE 1A
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-1292
Practice Address - Country:US
Practice Address - Phone:706-498-9560
Practice Address - Fax:706-498-9568
Is Sole Proprietor?:No
Enumeration Date:2015-09-06
Last Update Date:2025-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008396101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional