Provider Demographics
NPI:1902353360
Name:GIBSON, ALEX (MA)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:GIBSON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 CARPENTER DR STE 210
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20164-4468
Mailing Address - Country:US
Mailing Address - Phone:703-297-4368
Mailing Address - Fax:571-512-7955
Practice Address - Street 1:107 CARPENTER DR STE 210
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-4468
Practice Address - Country:US
Practice Address - Phone:703-297-4368
Practice Address - Fax:571-512-7955
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health