Basic Information
| Provider Information | |||||||||
| NPI: | 1265782767 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GIBSON | ||||||||
| FirstName: | TAMEKA | ||||||||
| MiddleName: | SPROLING | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MA, LPC , CRC, LADAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 CORPORATE HILL DR | ||||||||
| Address2: | 330 | ||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722054540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5019547470 | ||||||||
| FaxNumber: | 5019547420 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 CORPORATE HILL DR | ||||||||
| Address2: | 330 | ||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722054540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5019547470 | ||||||||
| FaxNumber: | 5019547420 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2012 | ||||||||
| LastUpdateDate: | 09/24/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | P1408060 | AR | Y | Behavioral Health & Social Service Providers | Counselor | Professional | 225C00000X | 00114996 | AR | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Counselor | 101YA0400X | 327L | AR | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.