Provider Demographics
NPI:1003961814
Name:HUBERT, MARISSA (LCSW, CADC)
Entity Type:Individual
Prefix:MS
First Name:MARISSA
Middle Name:
Last Name:HUBERT
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 SPRING BANK DR., BLDG. C, SUITE 7
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303
Mailing Address - Country:US
Mailing Address - Phone:812-453-8543
Mailing Address - Fax:270-685-6510
Practice Address - Street 1:1401 SPRING BANK DR., BLDG. C, SUITE 7
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303
Practice Address - Country:US
Practice Address - Phone:812-453-8543
Practice Address - Fax:270-685-6510
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5002101YA0400X
KY0981101YA0400X
IN87001318A101YA0400X
KY34071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)