Individual provider Active NPI

Cheryl Gibson, PHD

  • Professional Counselor
  • Decatur, GA
National Provider Identifier
1881068211
Registry record updated May 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
LPC009302 Issued in GA
Practice address
1814 Clairmont Rd
Decatur, GA 30033-3405
Phone
(404) 636-1457
Fax
(404) 636-7449
NPI assigned
Nov 23, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 28, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X APC005156 GA
Professional Counselor 101YP2500X LPC009302 GA Primary

Addresses

Primary practice location

1814 Clairmont Rd
Decatur, GA 30033-3405

Mailing address

3103 Clairmont Rd NE Ste B
Brookhaven, GA 30329-1043
Phone (404) 636-1457

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
APC005156GAMDProfessional Counselor
LPC009302GAMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Trinity Care Counseling Corporation Current Accepting new patients

Locations

2475 Northwinds Pkwy
Ste 200
Alpharetta, GA 30009
Phone (678) 702-4488

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1448236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590624000000",
    "number": "1881068211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3103 CLAIRMONT RD NE STE B",
            "city": "BROOKHAVEN",
            "state": "GA",
            "postal_code": "303291043",
            "telephone_number": "404-636-1457",
            "fax_number": "404-636-7449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1814 CLAIRMONT RD",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300333405",
            "telephone_number": "404-636-1457",
            "fax_number": "404-636-7449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "CHERYL",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-11-23",
        "last_updated": "2020-05-28",
        "certification_date": "2020-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "APC005156",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC009302",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2020; 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.