Individual
MR. DERRICK COURTNEY GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S LPC
Contact information
Practice address
2 CHATEAU LN, BARBOURSVILLE, WV 25504-1626
(304) 736-9662
(304) 733-0079
Mailing address
97 GREAT TEAYS BLVD, SUITE 6, SCOTT DEPOT, WV 25560-9815
(304) 757-6999
(304) 201-5019
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
1618
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1618
STATE LICENSE
WV
Enumeration date
11/05/2007
Last updated
08/02/2019
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