Provider Demographics
NPI:1659399673
Name:HUBERT, MICHELLE C (LMSW)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:C
Last Name:HUBERT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:CLAIRE
Other - Last Name:HUBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5467 ORCHARD LAKE RD
Mailing Address - Street 2:
Mailing Address - City:KEEGO HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48322
Mailing Address - Country:US
Mailing Address - Phone:248-210-0523
Mailing Address - Fax:586-753-0404
Practice Address - Street 1:5467 ORCHARD LAKE RD
Practice Address - Street 2:
Practice Address - City:KEEGO HARBOR
Practice Address - State:MI
Practice Address - Zip Code:48322
Practice Address - Country:US
Practice Address - Phone:248-210-0523
Practice Address - Fax:734-425-8350
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801078103104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIQ26426209Medicare ID - Type Unspecified