Provider Demographics
NPI:1265782767
Name:GIBSON, TAMEKA SPROLING (MA, LPC , CRC, LADAC)
Entity type:Individual
Prefix:MRS
First Name:TAMEKA
Middle Name:SPROLING
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MA, LPC , CRC, LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CORPORATE HILL DR
Mailing Address - Street 2:330
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-4540
Mailing Address - Country:US
Mailing Address - Phone:501-954-7470
Mailing Address - Fax:501-954-7420
Practice Address - Street 1:10 CORPORATE HILL DR
Practice Address - Street 2:330
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-4540
Practice Address - Country:US
Practice Address - Phone:501-954-7470
Practice Address - Fax:501-954-7420
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARP1408060101YP2500X
AR00114996225C00000X
AR327L101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)