Provider Demographics
NPI:1023377553
Name:GIBBS, STEPHANIE (MFT)
Entity type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:
Last Name:GIBBS
Suffix:
Gender:
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 SHELL DR APT 193
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28390-2073
Mailing Address - Country:US
Mailing Address - Phone:412-623-9550
Mailing Address - Fax:
Practice Address - Street 1:921 SHELL DR APT 193
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NC
Practice Address - Zip Code:28390-2073
Practice Address - Country:US
Practice Address - Phone:412-623-9550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-03
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
PAMF001091106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist