Individual
MRS. LINDA ELIZABETH GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
180 COASTAL LN, JACKSONVILLE, NC 28546-6761
(910) 455-6724
(910) 346-5489
Mailing address
180 COASTAL LN, JACKSONVILLE, NC 28546-6761
(910) 455-6724
(910) 346-5489
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL-067-026
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3408956
—
NC
Enumeration date
06/19/2008
Last updated
06/19/2015
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