Individual
VANESSA GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, LLP
Contact information
Practice address
835 MASON ST STE B220, DEARBORN, MI 48124-2262
(313) 561-9064
(313) 563-4480
Mailing address
835 MASON ST STE B220, DEARBORN, MI 48124-2262
(313) 561-9064
(313) 563-4480
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6361003791
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6301011057
LICENSE
MI
01
—
6361003791
LICENSE
MI
01
—
V0011057
BLUE CROSS BLUE SHIELD
MI
Enumeration date
01/03/2007
Last updated
05/01/2024
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