Individual
MISS KENDALL MAREE GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
910 COOK RD, ORANGEBURG, SC 29118-2124
(803) 534-2328
Mailing address
910 COOK RD, ORANGEBURG, SC 29118-2124
(803) 534-2328
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
570609170
—
SC
Enumeration date
02/25/2020
Last updated
02/25/2020
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