Provider Demographics
NPI:1841431897
Name:HUBAY, DIANNA M (LMFT)
Entity Type:Individual
Prefix:MS
First Name:DIANNA
Middle Name:M
Last Name:HUBAY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10119 BIG CANOE
Mailing Address - Street 2:
Mailing Address - City:BIG CANOE
Mailing Address - State:GA
Mailing Address - Zip Code:30143-5117
Mailing Address - Country:US
Mailing Address - Phone:770-365-5095
Mailing Address - Fax:706-579-2013
Practice Address - Street 1:2404 REFUGE RD
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-4946
Practice Address - Country:US
Practice Address - Phone:706-692-7209
Practice Address - Fax:706-692-0144
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT000857106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist