Provider Demographics
NPI:1841424918
Name:JOHN F. KUBIAK, LMFT, PLLC
Entity Type:Organization
Organization Name:JOHN F. KUBIAK, LMFT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:KUBIAK
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:919-302-8297
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:27587-4487
Practice Address - Country:US
Practice Address - Phone:919-302-8297
Practice Address - Fax:919-803-1770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1156106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6105162Medicaid