Individual
MS. GRACE CRYSTAL GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C S A C
Contact information
Practice address
311 W 35TH ST, NEW YORK, NY 10001-1701
(212) 736-5900
(212) 967-0723
Mailing address
311 W 35TH ST, NEW YORK, NY 10001-1701
(212) 736-5900
(212) 967-0723
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
26103
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1609805993
—
NY
Enumeration date
02/07/2012
Last updated
02/07/2012
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