Healthcare Provider Details

I. General information

NPI: 1659399673
Provider Name (Legal Business Name): MICHELLE C HUBERT LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. MICHELLE CLAIRE HUBERT

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 12/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5467 ORCHARD LAKE RD
KEEGO HARBOR MI
48322
US

IV. Provider business mailing address

5467 ORCHARD LAKE RD
KEEGO HARBOR MI
48322
US

V. Phone/Fax

Practice location:
  • Phone: 248-210-0523
  • Fax: 734-425-8350
Mailing address:
  • Phone: 248-210-0523
  • Fax: 586-753-0404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801078103
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: