Individual
CHASITY GIBBONS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1924 N LEG RD APT 1G, AUGUSTA, GA 30909-4436
(478) 444-8199
Mailing address
1400 GRAY HWY APT 402, MACON, GA 31211-1927
(478) 444-8199
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
BACB1007399
GA
Other
Enumeration date
12/20/2023
Last updated
12/20/2023
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