Provider Demographics
NPI:1699570226
Name:GIBSON, MOARASHAD (RMA, CADC)
Entity type:Individual
Prefix:
First Name:MOARASHAD
Middle Name:
Last Name:GIBSON
Suffix:
Gender:
Credentials:RMA, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 GUILFORD COLLEGE RD APT N
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27409-2298
Mailing Address - Country:US
Mailing Address - Phone:910-217-7000
Mailing Address - Fax:
Practice Address - Street 1:1617 S HAWTHORNE RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4127
Practice Address - Country:US
Practice Address - Phone:336-750-6380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCADC-28759101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)