Provider Demographics
NPI:1447598438
Name:GIBSON, TWAQUANA
Entity type:Individual
Prefix:MS
First Name:TWAQUANA
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TWAQUANA
Other - Middle Name:
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:515 N PARK AVE
Mailing Address - Street 2:SUITE 201A
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-3634
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:515 N PARK AVE
Practice Address - Street 2:SUITE 201A
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-3634
Practice Address - Country:US
Practice Address - Phone:407-814-2220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-25
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool