Individual
CANDICE GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
707 SOUTHFIELD RD, SHREVEPORT, LA 71106-2219
(318) 869-1632
Mailing address
707 SOUTHFIELD RD, SHREVEPORT, LA 71106-2219
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
16764
LA
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
171M0000X
—
LA
Enumeration date
09/29/2021
Last updated
04/13/2026
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