Provider Demographics
NPI:1033369475
Name:HUBBARD, CAROLYN RENEE II (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:RENEE
Last Name:HUBBARD
Suffix:II
Gender:F
Credentials:LCSW
Other - Prefix:
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Mailing Address - Street 1:190 BEECH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GATE CITY
Mailing Address - State:VA
Mailing Address - Zip Code:24251-3623
Mailing Address - Country:US
Mailing Address - Phone:276-386-3803
Mailing Address - Fax:276-386-2116
Practice Address - Street 1:190 BEECH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:GATE CITY
Practice Address - State:VA
Practice Address - Zip Code:24251-3623
Practice Address - Country:US
Practice Address - Phone:276-386-3803
Practice Address - Fax:276-386-2116
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040047401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical