Individual
JIMMY GIBBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
21 OLD ROUTE 6, CARMEL, NY 10512-2107
(845) 225-5202
(845) 704-6178
Mailing address
79 GLENRIDGE RD, GLENVILLE, NY 12302-4523
(518) 952-8408
(518) 399-6860
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01420795
—
NY
Enumeration date
05/08/2018
Last updated
05/08/2018
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