Provider Demographics
NPI:1023439270
Name:DENISE M HUBERT, LMSW PROFESSIONAL LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:DENISE M HUBERT, LMSW PROFESSIONAL LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HUBERT
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:586-855-5022
Mailing Address - Street 1:16950 19 MILE RD
Mailing Address - Street 2:SUITE 3F
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-4804
Mailing Address - Country:US
Mailing Address - Phone:586-855-5022
Mailing Address - Fax:586-855-5026
Practice Address - Street 1:16950 19 MILE RD
Practice Address - Street 2:SUITE 3F
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-4804
Practice Address - Country:US
Practice Address - Phone:586-855-5022
Practice Address - Fax:586-855-5026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801074246251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health