Provider Demographics
NPI:1699464859
Name:GIBSON, HARRIET CLEMENTINE (BA)
Entity type:Individual
Prefix:
First Name:HARRIET
Middle Name:CLEMENTINE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1201
Mailing Address - Street 2:
Mailing Address - City:FORT GAY
Mailing Address - State:WV
Mailing Address - Zip Code:25514-1201
Mailing Address - Country:US
Mailing Address - Phone:606-225-9269
Mailing Address - Fax:
Practice Address - Street 1:20824 ROUTE 52
Practice Address - Street 2:
Practice Address - City:FORT GAY
Practice Address - State:WV
Practice Address - Zip Code:25514-7074
Practice Address - Country:US
Practice Address - Phone:304-648-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor