Individual
FANTA GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, CDP
Contact information
Practice address
1900 E MAIN ST, VA ILLIANA HEALTHCARE SYSTEM, SOCIAL WORK DEPT, DANVILLE, IL 61832-5100
(217) 554-3000
Mailing address
1900 E MAIN ST, DANVILLE, IL 61832-5100
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
4059-C
AR
Other
Enumeration date
03/26/2019
Last updated
08/10/2021
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