Michael James Gibbons, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904055672 Issued in VA

Practice address

30 Crossing LN Ste 201
Lexington, VA 24450-6354

Phone

(540) 319-0053

Fax

(540) 492-5581

NPI assigned

Oct 12, 2022

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kelland Psychological Services, LLC

  • Clinical Psychologist
  • Lexington, VA
  • NPI 1679421267
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1665532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665532800000",
    "number": "1013632033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 CROSSING LN STE 201",
            "city": "LEXINGTON",
            "state": "VA",
            "postal_code": "244506354",
            "telephone_number": "540-817-3247",
            "fax_number": "540-492-5581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 CROSSING LN STE 201",
            "city": "LEXINGTON",
            "state": "VA",
            "postal_code": "244506354",
            "telephone_number": "540-319-0053",
            "fax_number": "540-492-5581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBBONS",
        "first_name": "MICHAEL",
        "middle_name": "JAMES",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-10-12",
        "last_updated": "2022-10-12",
        "certification_date": "2022-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904055672",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Calvin A. Funkhouser, DO
• Brian Fuquay, DO
• Helen Chandler Fure, OD
• Elayne Garrett
• Suzanna Johnston Garrett, NCTMB
• Catherine Giese, LPTA
• Marco Giuliani, ATC
• April Marie Goad, OTA
• Jeffrey Steven Goldstein, RPH
• Anna Musselman Goodbar, MPT

• Clinical Social Worker in Lexington, VA
• Providers in Lexington, VA by specialty
• Clinical Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.