Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 0981 | KY |
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 5002 | KY |
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 87001318A | IN |
Y | 1041C0700X | Clinical Social Worker | 3407 | KY |
NPI | 1003961814 |
---|---|
Provider Name | Ms. Marissa Hubert |
First Address | Owensboro, KY 42303 |
Second Address | Owensboro, KY 42303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2007 |
Last Update Date | 28/05/2014 |