Kristian Antionette Gibson-Ford, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C012286 Issued in NC

Practice address

3323 Cotton Press St
Raleigh, NC 27614-8675

Phone

(317) 507-6450

NPI assigned

May 22, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Indiana Medical College, School of Medicine of Purdue University, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

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.

• Harmony 360 Counseling

  • Clinical Social Worker
  • Wake Forest, NC
  • NPI 1235709692

  Mental Health

  Medicare reassignment NPD Authorized official
• Premise Health of North Carolina Medical PC

  dba Wake County East Campus

  • Multi-Specialty Clinic/Center
  • Raleigh, NC
  • NPI 1427575869
  Medicare reassignment NPD
• Premise Health of North Carolina Medical PC

  dba Wake County Downtown Campus

  • Multi-Specialty Clinic/Center
  • Raleigh, NC
  • NPI 1790202133
  NPD

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

{
    "created_epoch": "1526947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624924800000",
    "number": "1841781119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3323 COTTON PRESS ST",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276148675",
            "telephone_number": "317-507-6450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3323 COTTON PRESS ST",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276148675",
            "telephone_number": "317-507-6450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON-FORD",
        "first_name": "KRISTIAN",
        "middle_name": "ANTIONETTE",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-05-22",
        "last_updated": "2021-06-29",
        "certification_date": "2021-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34006886A",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C012286",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "C012286",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristianna Giannico
• Christa Gibbs
• Jennifer Gibbs, FNP
• Nettie Gibbs
• Gibson Homes LLC
• Annamaria Gibson
• Asya Gibson
• Cindy Gibson, CCC-SLP
• Colin Desmond Gibson, M.D.
• Debra Luanne Gibson, M.D.

• Clinical Social Worker in Raleigh, NC
• Providers in Raleigh, 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 Jun 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.