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General NPI Number Information
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NPI Number | 1023505146
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Entity Type | Individual
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Provider Name | KEVIN JUSTIN HUBBARD LPC
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Gender | Male
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Dates
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Enumeration Date | 04/13/2018
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Last Update Date | 04/13/2018
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Provider Practice Location Address
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Address Line | 3900 FORD RD STE E
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City | PHILADELPHIA
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State | PA
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Zip | 19131-2001
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Country | US
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Telephone | 267-908-6363
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Fax |
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Provider Business Mailing Address
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Address Line | 24-4 VALLEY RD
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City | DREXEL HILL
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State | PA
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Zip | 19026-5414
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Country | US
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Telephone | 484-682-5615
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC010091
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License Number State | PA
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