Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
N | 101YM0800X | Mental Health Counselor | ||
Y | 101YP2500X | Professional Counselor | ||
N | 101YS0200X | School Counselor |
NPI | 1104210848 |
---|---|
Provider Name | Leslie Hubbard |
First Address | Farmington, CT 06032-2217 |
Second Address | Farmington, CT 06032-2217 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2015 |
Last Update Date | 19/03/2015 |