Provider Demographics
NPI:1699074682
Name:GIBSON, BARTLEY D (MSW LICSW)
Entity type:Individual
Prefix:
First Name:BARTLEY
Middle Name:D
Last Name:GIBSON
Suffix:
Gender:M
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CRAMERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28032-1407
Mailing Address - Country:US
Mailing Address - Phone:304-281-8920
Mailing Address - Fax:
Practice Address - Street 1:75 POPLAR ST
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-7058
Practice Address - Country:US
Practice Address - Phone:304-281-8920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009415361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical