Healthcare Provider Details

I. General information

NPI: 1770538126
Provider Name (Legal Business Name): BOBBIE RENEE HUBBARD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 04/26/2025
Certification Date: 04/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 WHITING WAY STE 110
WARNER ROBINS GA
31088-8054
US

IV. Provider business mailing address

104 WHITING WAY STE 110
WARNER ROBINS GA
31088-8054
US

V. Phone/Fax

Practice location:
  • Phone: 912-712-2397
  • Fax:
Mailing address:
  • Phone: 912-712-2397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCSW004050
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW004050
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: