Individual
DIAMOND GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
113 SALEM TPKE STE 200, NORWICH, CT 06360-6484
(726) 201-3549
Mailing address
15 MOPSIC CT APT 209, NORWICH, CT 06360-5647
(860) 574-0593
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
06/21/2024
Last updated
06/21/2024
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