Justin Wade Gibson, LCSW, LCASA

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C014663 Issued in NC

Practice address

309 Progress Dr
Burgaw, NC 28425-3280

Phone

(910) 259-0668

Fax

(910) 202-9966

NPI assigned

Oct 15, 2019

Last updated

Mar 1, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1571097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646092800000",
    "number": "1508408105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 SHIPYARD BLVD",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284126431",
            "telephone_number": "910-343-0145",
            "fax_number": "910-202-9966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 PROGRESS DR",
            "city": "BURGAW",
            "state": "NC",
            "postal_code": "284253280",
            "telephone_number": "910-259-0668",
            "fax_number": "910-202-9966"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "615 Shipyard Blvd",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "28412",
            "country_code": "US",
            "telephone_number": "910-343-0145",
            "fax_number": "910-202-9966",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "JUSTIN",
        "middle_name": "WADE",
        "credential": "LCSW, LCASA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-10-15",
        "last_updated": "2022-03-01",
        "certification_date": "2022-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "24725",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C014663",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "81-5150377",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alisa Fussell
• Bianca Gangale, LCMHCA, NCC
• Kirsten Garay, LCSW
• Gustavo Gasca Jr. Jr., DMD
• Courtney L Gibbs, MS, CCC-SLP
• Hannah Suzanne Gould, SLPA
• Tonia Whitley Gray, NURSE PRACTITIONER
• Linda I Greenspan, D.O.
• Deborah Dawn Grim
• Chantelle Nicolle Guthrie, FNP

• Clinical Social Worker in Burgaw, NC
• Providers in Burgaw, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 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.