Individual
MRS. DIANNE GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2901 BAKERS MILL RD, FAYETTEVILLE, NC 28306-8273
(910) 423-8816
(910) 423-8816
Mailing address
2901 BAKERS MILL RD, 2901 BAKERS MILL RD, FAYETTEVILLE, NC 28306-8273
(910) 423-8816
(910) 423-8816
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3409525
—
NC
Enumeration date
01/10/2007
Last updated
07/09/2007
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