Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist |
NPI | 1083108187 |
---|---|
Provider Name | Dr. Andrew Scott Gibson |
First Address | Greenville, SC 29601-4902 |
Second Address | Greenville, SC 29601-4902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2018 |
Last Update Date | 02/01/2020 |