Provider Demographics
NPI:1538451968
Name:GIBBONS, WILLIAM GREGORY (MA, CASAC, LCAS,)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:GREGORY
Last Name:GIBBONS
Suffix:
Gender:M
Credentials:MA, CASAC, LCAS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 LANAI LN
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-4203
Mailing Address - Country:US
Mailing Address - Phone:919-724-0916
Mailing Address - Fax:
Practice Address - Street 1:8 LANAI LN
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-4203
Practice Address - Country:US
Practice Address - Phone:919-724-0916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-03
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY906101YA0400X
NCLCAS #1002101YA0400X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)