Provider Demographics
NPI:1336902964
Name:HUBBARD, STEPHANIE LOU (CPSS, CSA)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:LOU
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:CPSS, CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 BRIGHT LEAF DR
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-7306
Mailing Address - Country:US
Mailing Address - Phone:606-425-1646
Mailing Address - Fax:
Practice Address - Street 1:233 PARKERS MILL WAY
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-4152
Practice Address - Country:US
Practice Address - Phone:606-425-1646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility