Individual
MR. DWAYNE LEE GIBSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW, CDCA
Contact information
Practice address
5416 GLENRIDGE DR, TOLEDO, OH 43614-1608
(419) 705-2169
Mailing address
5416 GLENRIDGE DR, TOLEDO, OH 43614-1608
(419) 705-2169
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
090176
OH
Other
Enumeration date
12/27/2010
Last updated
12/27/2010
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