Provider Demographics
NPI:1982083796
Name:GIBSON, OLIVIA ELLIS (LCSW)
Entity type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:ELLIS
Last Name:GIBSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 FRONT ST STE 116-129
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-5078
Mailing Address - Country:US
Mailing Address - Phone:615-219-9932
Mailing Address - Fax:
Practice Address - Street 1:1028 STATE BLVD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-8643
Practice Address - Country:US
Practice Address - Phone:615-219-9932
Practice Address - Fax:615-622-1196
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000060171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical