James Leonce Gibson III, SUDRC
Counselor, Addiction (Substance Use Disorder) in Stockton, CA. Individual provider (NPI-1).
NPI number1841908183
StatusActive
Last updated in NPPESNov 7, 2022
Details
- NPI
- 1841908183
- Entity type
- Individual (NPI-1)
- Name
- Mr. James Leonce Gibson III
- Credential
- SUDRC
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Nov 7, 2022
- Certification date
- Nov 6, 2022
- Last updated
- Nov 7, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YA0400X | Counselor, Addiction (Substance Use Disorder) | 39007BN | CA | Yes |
Practice location
1981 Cherokee RdStockton, CA 95205-2720
Phone 209-870-6500
Mailing address
1981 Cherokee RdStockton, CA 95205-2720
Phone 209-870-6500
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