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Individual
MELISSA RAEN'E GIBBONS
Active
Individual
MELISSA RAEN'E GIBBONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LLMSW
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6801102550
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6801102550
DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS - MASTER LTD SOCIAL WORKER
MI
Enumeration date
12/25/2018
Last updated
12/25/2018
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