Individual
MS. MARY PUCKETT GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., NCC, LPC
Contact information
Practice address
223 SCENIC HWY, SUITE 100, LAWRENCEVILLE, GA 30045-5603
(770) 995-1846
(770) 995-6614
Mailing address
2485 HINTON RD, DACULA, GA 30019-2155
(678) 377-2285
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC003992
GA
Other
Enumeration date
10/20/2005
Last updated
07/23/2014
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