Provider Demographics
NPI:1841814779
Name:HUBBARD, MOLLY (LMSW)
Entity type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5955 W MAIN ST STE 504
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-9101
Mailing Address - Country:US
Mailing Address - Phone:313-410-0240
Mailing Address - Fax:
Practice Address - Street 1:5955 W MAIN ST STE 504
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-9101
Practice Address - Country:US
Practice Address - Phone:616-220-0644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-06
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010956291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty