Provider Demographics
NPI:1649532508
Name:LUBKA, LORRAINE ANNE (MS LMFT)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:ANNE
Last Name:LUBKA
Suffix:
Gender:F
Credentials:MS LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 BISHOPS BLVD S
Mailing Address - Street 2:SUITE B
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-7608
Mailing Address - Country:US
Mailing Address - Phone:701-235-4457
Mailing Address - Fax:
Practice Address - Street 1:5201 BISHOPS BLVD S
Practice Address - Street 2:SUITE B
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7608
Practice Address - Country:US
Practice Address - Phone:701-235-4457
Practice Address - Fax:701-356-7993
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2009-026106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist