Provider Demographics
NPI:1790458974
Name:HUBBARD, KIARA S
Entity Type:Individual
Prefix:
First Name:KIARA
Middle Name:S
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3087 SIMPSON HIGHWAY 13
Mailing Address - Street 2:
Mailing Address - City:MENDENHALL
Mailing Address - State:MS
Mailing Address - Zip Code:39114-3077
Mailing Address - Country:US
Mailing Address - Phone:601-847-4410
Mailing Address - Fax:
Practice Address - Street 1:3087 SIMPSON HIGHWAY 13
Practice Address - Street 2:
Practice Address - City:MENDENHALL
Practice Address - State:MS
Practice Address - Zip Code:39114-3077
Practice Address - Country:US
Practice Address - Phone:601-847-4410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health