Provider Demographics
NPI:1003361528
Name:HUBBARD, LATASHA NICOLE
Entity Type:Individual
Prefix:
First Name:LATASHA
Middle Name:NICOLE
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 STONERIDGE ST
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-5445
Mailing Address - Country:US
Mailing Address - Phone:434-942-7418
Mailing Address - Fax:
Practice Address - Street 1:233 STONERIDGE ST
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-5445
Practice Address - Country:US
Practice Address - Phone:434-942-7418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor