Provider Demographics
NPI:1003687559
Name:HUBBARD, CHEYENNE DAKOTA (LCADC)
Entity Type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:DAKOTA
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10322 PINOAK VIEW DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-6847
Mailing Address - Country:US
Mailing Address - Phone:606-202-0044
Mailing Address - Fax:
Practice Address - Street 1:1402 BROWNS LN STE A
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4609
Practice Address - Country:US
Practice Address - Phone:502-894-0234
Practice Address - Fax:502-894-9858
Is Sole Proprietor?:No
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY288006101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)