Individual
NICOLE MARIE GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CASAC-T
Contact information
Practice address
321 W ONONDAGA ST, SYRACUSE, NY 13202-3207
(315) 478-0610
Mailing address
133 MCKINLEY AVE, SYRACUSE, NY 13205-1513
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
31404
NY
Other
Enumeration date
10/24/2017
Last updated
10/24/2017
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