Provider Demographics
NPI:1861059628
Name:GIBBS, ALETA (RESIDENT IN COUNSELI)
Entity type:Individual
Prefix:
First Name:ALETA
Middle Name:
Last Name:GIBBS
Suffix:
Gender:F
Credentials:RESIDENT IN COUNSELI
Other - Prefix:
Other - First Name:ALETA
Other - Middle Name:
Other - Last Name:SEAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:620 COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:BASSETT
Mailing Address - State:VA
Mailing Address - Zip Code:24055-5157
Mailing Address - Country:US
Mailing Address - Phone:276-732-8111
Mailing Address - Fax:
Practice Address - Street 1:620 COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:BASSETT
Practice Address - State:VA
Practice Address - Zip Code:24055-5157
Practice Address - Country:US
Practice Address - Phone:276-732-8111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704013271101Y00000X
VA0719000012101YA0400X
343900000X
0704013271101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)