Individual
ALISA KAYE GIBSON RICHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCMHCA
Contact information
Practice address
311 WILLIAMSON RD STE 103, MOORESVILLE, NC 28117-5967
(704) 360-3049
Mailing address
2116 MCCLINTOCK RD UNIT 232, CHARLOTTE, NC 28205-5159
(864) 314-4988
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
A14341
NC
101YP2500X
Professional Counselor
Primary
A14341
NC
Other
Enumeration date
10/01/2018
Last updated
01/24/2022
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