Individual
MR. KENT DOUGLAS GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.I.S.W.
Contact information
Practice address
1500VERANDA DR. SE, RIO RANCHO, NM 87124-3897
(505) 994-0229
Mailing address
3704 ARBOLEDA SENDA, NE, ALBUQUERQUE, NM 87111
(505) 275-3134
Taxonomy
Speciality
Code
Description
License number
State
1041S0200X
School Social Worker
Primary
I-3997
NM
Other
Enumeration date
04/19/2007
Last updated
07/08/2007
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