Healthcare Provider Details

I. General information

NPI: 1568455186
Provider Name (Legal Business Name): CAROL MARGARET SCHUBECK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 12/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12625 N GENTLE RAIN DR
MARANA AZ
85658-4394
US

IV. Provider business mailing address

12625 N GENTLE RAIN DR
MARANA AZ
85658-4394
US

V. Phone/Fax

Practice location:
  • Phone: 520-222-2012
  • Fax:
Mailing address:
  • Phone: 520-222-2012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number15933
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number15933
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCS#15933
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: