Provider Demographics
NPI:1720332984
Name:GIBBS RANKIN, CAROLYN (LMFT)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:GIBBS RANKIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1161 MOUNTAIN PINE RD
Mailing Address - Street 2:
Mailing Address - City:CLOVERDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95425-4304
Mailing Address - Country:US
Mailing Address - Phone:707-635-9504
Mailing Address - Fax:
Practice Address - Street 1:216 N CLOVERDALE BLVD
Practice Address - Street 2:
Practice Address - City:CLOVERDALE
Practice Address - State:CA
Practice Address - Zip Code:95425-3362
Practice Address - Country:US
Practice Address - Phone:707-635-9504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-08
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT24618106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist