Susann Renee Light-Gibson, MED, CSAC

Primary specialty

CounselorTaxonomy code 101Y00000X

License

0710102161 Issued in VA

Practice address

3169 2ND Ave E
Big Stone Gap, VA 24219-3805

Phone

(276) 523-8300

Fax

(276) 523-6964

NPI assigned

Feb 21, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Credentials

Master of Education

State licenses

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

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1649315300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9054",
            "city": "GRAY",
            "state": "TN",
            "postal_code": "376159054",
            "telephone_number": "423-467-3600",
            "fax_number": "423-467-3644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3169 2ND AVE E",
            "city": "BIG STONE GAP",
            "state": "VA",
            "postal_code": "242193805",
            "telephone_number": "276-523-8300",
            "fax_number": "276-523-6964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIGHT-GIBSON",
        "first_name": "SUSANN",
        "middle_name": "RENEE",
        "name_prefix": "Mrs.",
        "credential": "MED, CSAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "VA",
            "license": "0710102161",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Counselor in Big Stone Gap, VA
• Providers in Big Stone Gap, VA by specialty
• Counselor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.