Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 0813000349 | VA |
NPI | 1013415405 |
---|---|
Provider Name | Juliet Dacal Gibson |
First Address | Buena Vista, VA 24416-2621 |
Second Address | Buena Vista, VA 24416-2621 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2018 |
Last Update Date | 31/01/2018 |