Provider Demographics
NPI:1043385347
Name:KUBIAK, JOHN F (LMFT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:KUBIAK
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 SHADOW CREEK DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-5891
Mailing Address - Country:US
Mailing Address - Phone:919-302-8297
Mailing Address - Fax:919-803-1770
Practice Address - Street 1:3206 HERITAGE TRADE DR
Practice Address - Street 2:SUITE 108-A
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-4486
Practice Address - Country:US
Practice Address - Phone:919-302-8297
Practice Address - Fax:919-803-1770
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2009-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1156106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6105162Medicaid