Healthcare Provider Details

I. General information

NPI: 1922203322
Provider Name (Legal Business Name): PHILIP MICHAEL HUBER LPC, ACS, LCADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 02/14/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 DELSEA DR # 1145
WESTVILLE NJ
08093-2266
US

IV. Provider business mailing address

1170 DELSEA DR # 1145
WESTVILLE NJ
08093-2266
US

V. Phone/Fax

Practice location:
  • Phone: 856-506-9084
  • Fax: 856-853-0919
Mailing address:
  • Phone: 856-506-9084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00298700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: