Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 327L | AR |
Y | 101YP2500X | Professional Counselor | P1408060 | AR |
N | 225C00000X | Rehabilitation Counselor | 00114996 | AR |
NPI | 1265782767 |
---|---|
Provider Name | Mrs. Tameka Sproling Gibson |
First Address | Little Rock, AR 72205-4540 |
Second Address | Little Rock, AR 72205-4540 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2012 |
Last Update Date | 24/09/2015 |