Individual
EMILY ELISE GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC I
Contact information
Practice address
1 SERENITY LN, COBURG, OR 97408-9350
(541) 687-1110
Mailing address
PO BOX 8549, COBURG, OR 97408-1313
(541) 687-1110
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
18-02-07
OR
Other
Enumeration date
03/30/2018
Last updated
03/30/2018
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