Healthcare Provider Details

I. General information

NPI: 1982584033
Provider Name (Legal Business Name): MICHAEL JOSEPH HUBBARD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 VICTORY LN BLDG 3
WINTERVILLE NC
28590-9222
US

IV. Provider business mailing address

100 KIMEL FOREST DR
WINSTON SALEM NC
27103-6074
US

V. Phone/Fax

Practice location:
  • Phone: 252-355-2801
  • Fax: 252-355-4708
Mailing address:
  • Phone: 336-716-9034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP022946
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: