Individual
MRS. CONNIE GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
121 JACKSON ST, NEWNAN, GA 30263-1572
(770) 251-5873
(770) 304-2201
Mailing address
121 JACKSON ST, NEWNAN, GA 30263-1572
(770) 251-5873
(770) 304-2201
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1876
GA
101YP2500X
Professional Counselor
Primary
LPC006647
GA
Other
Enumeration date
11/22/2013
Last updated
11/22/2013
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