Provider Demographics
NPI:1881854446
Name:HUBBERTS, DIANA S (LCPC, MS)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:S
Last Name:HUBBERTS
Suffix:
Gender:F
Credentials:LCPC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 E LILAC TER
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-3528
Mailing Address - Country:US
Mailing Address - Phone:847-818-8629
Mailing Address - Fax:
Practice Address - Street 1:1815 E LILAC TER
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-3528
Practice Address - Country:US
Practice Address - Phone:847-818-8629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.006755101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional