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General NPI Number Information
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NPI Number | 1083070338
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Entity Type | Individual
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Provider Name | KRISTEN HUBBARD BCBA
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Gender | Female
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Dates
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Enumeration Date | 12/31/2015
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Last Update Date | 04/27/2019
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Provider Practice Location Address
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Address Line | 1310 WOODROW ST
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City | COLUMBIA
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State | SC
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Zip | 29205-1229
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Country | US
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Telephone | 803-466-4089
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Fax |
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Provider Business Mailing Address
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Address Line | 959 E MAIN ST APT 526
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City | LEXINGTON
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State | SC
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Zip | 29072-4262
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Country | US
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Telephone | 562-468-8989
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-19-35246
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License Number State | SC
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