Provider Demographics
NPI:1720731417
Name:HUBBARD, JEANINE (MS, LMFTA)
Entity Type:Individual
Prefix:
First Name:JEANINE
Middle Name:
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:MS, LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 N CHARLOTTE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-2525
Mailing Address - Country:US
Mailing Address - Phone:980-500-9138
Mailing Address - Fax:704-684-4656
Practice Address - Street 1:1501 N CHARLOTTE AVE STE B
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-2525
Practice Address - Country:US
Practice Address - Phone:980-500-9138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12377A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist