1932439163 NPI number — MRS. VERONICA WARREN GIBSON M.A., LLPC

Table of content: MRS. VERONICA WARREN GIBSON M.A., LLPC (NPI 1932439163)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932439163 NPI number — MRS. VERONICA WARREN GIBSON M.A., LLPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIBSON
Provider First Name:
VERONICA
Provider Middle Name:
WARREN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A., LLPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932439163
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18131 REDWOOD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LATHRUP VILLAGE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48076-2624
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-587-1923
Provider Business Mailing Address Fax Number:
313-833-2841

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1025 E FOREST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48207-1024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-833-0284
Provider Business Practice Location Address Fax Number:
313-833-2841
Provider Enumeration Date:
01/11/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  6401011519 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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