Provider Demographics
NPI:1023630498
Name:HUBBARD, DEWANA RENA (MFT/LPCC)
Entity type:Individual
Prefix:
First Name:DEWANA
Middle Name:RENA
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:MFT/LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19510 VAN BUREN BLVD # F3402
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-9457
Mailing Address - Country:US
Mailing Address - Phone:657-229-0322
Mailing Address - Fax:
Practice Address - Street 1:29970 TECHNOLOGY DR STE 109
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2646
Practice Address - Country:US
Practice Address - Phone:951-900-4414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC7710101YM0800X
CAAMFT117754101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAMFT117754OtherBOARD OF BEHAVIORAL SCIENCES
CAAPCC7710OtherBOARD OF BEHAVIORAL SCIENCES