Provider Demographics
NPI:1669428751
Name:GIBBLE, LAUREN (LCPC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:GIBBLE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:JILL
Other - Last Name:ST CLAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:13121 BROOK LANE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-1514
Mailing Address - Country:US
Mailing Address - Phone:301-733-0331
Mailing Address - Fax:301-733-4038
Practice Address - Street 1:13215 BROOK LANE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742
Practice Address - Country:US
Practice Address - Phone:301-733-0331
Practice Address - Fax:301-733-4038
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2312101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD986965400Medicaid
MD986965400Medicaid