Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003112442 |
---|---|
Provider Name | Ms. Charmin Meyatta Gibson |
First Address | Saint Louis, MO 63106-1621 |
Second Address | Saint Louis, MO 63106-1621 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2011 |
Last Update Date | 02/02/2011 |