Provider Demographics
NPI:1750074688
Name:EBUBE, CARLA LEE MAE (LCSW)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:LEE MAE
Last Name:EBUBE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:LEE MAE
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NONE
Mailing Address - Street 1:309 S HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-2103
Mailing Address - Country:US
Mailing Address - Phone:760-718-8153
Mailing Address - Fax:
Practice Address - Street 1:309 S HIGH ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2103
Practice Address - Country:US
Practice Address - Phone:760-718-8153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI50021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty