Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 180010979 | IL |
NPI | 1003223777 |
---|---|
Provider Name | Ms. Jovita Hubbard |
First Address | Merrillville, IN 46410 |
Second Address | Chicago, IL 60628-5015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2014 |
Last Update Date | 18/05/2017 |