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Organization
JEANNIE GIBERSON
Active
Organization
JEANNIE GIBERSON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JEANNIE JUNIOR GIBERSON LCSW (CLINICIAN)
(352) 467-4457
Entity
Organization
Contact information
Practice address
4313 TAHITIAN GARDENS DRIVE K2, HOLIDAY, FL 34691
(352) 467-4457
Mailing address
4313 TAHITIAN GARDENS DRIVE K2, K2, HOLIDAY, FL 34691
(352) 467-4457
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
SW13517
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4902
MENTAL HEALTH
FL
05
—
4902
—
FL
Enumeration date
05/24/2016
Last updated
05/24/2016
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