Provider Demographics
NPI:1235217779
Name:HUBBARD, CHRISTIE MICHELLE (MSW)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:MICHELLE
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 W MINTHORN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-2808
Mailing Address - Country:US
Mailing Address - Phone:951-245-3299
Mailing Address - Fax:
Practice Address - Street 1:1400 W MINTHORN ST
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-2808
Practice Address - Country:US
Practice Address - Phone:951-245-3299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15819101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health