Provider Demographics
NPI:1447840772
Name:GIBSON, VERA MONIQUE (LPCA)
Entity type:Individual
Prefix:MRS
First Name:VERA
Middle Name:MONIQUE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:VERA
Other - Middle Name:MONIQUE
Other - Last Name:ROSENKRANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2719 NEUSE BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-2857
Mailing Address - Country:US
Mailing Address - Phone:951-852-6446
Mailing Address - Fax:
Practice Address - Street 1:2719 NEUSE BLVD STE D
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2857
Practice Address - Country:US
Practice Address - Phone:252-514-9888
Practice Address - Fax:252-514-2881
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16283101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health