Individual
TACQUETTA MYRTELLE GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6439 GARNERS FERRY RD, COLUMBIA, SC 29209-1638
(803) 776-4000
Mailing address
628 STONO DR, BLYTHEWOOD, SC 29016-7339
(803) 873-8263
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
15842
SC
Other
Enumeration date
08/01/2024
Last updated
08/01/2024
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