Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003434036 |
---|---|
Provider Name | Steven James Gibbons |
First Address | Quincy, MA 02169-6764 |
Second Address | Quincy, MA 02169-6764 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2020 |
Last Update Date | 07/07/2020 |