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General NPI Number Information
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NPI Number | 1962699702
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Entity Type | Individual
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Provider Name | PAULETTE DENISE HUBBERT LCSW,CSAC
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Gender | Female
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Dates
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Enumeration Date | 09/25/2007
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Last Update Date | 01/19/2022
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Provider Practice Location Address
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Address Line | 211 N UNION ST STE 100
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City | ALEXANDRIA
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State | VA
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Zip | 22314-2643
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Country | US
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Telephone | 703-672-0393
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Fax | 855-282-5282
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Provider Business Mailing Address
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Address Line | 15107 LEICESTERSHIRE ST
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City | WOODBRIDGE
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State | VA
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Zip | 22191-6545
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Country | US
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Telephone | 816-785-3876
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2005004578
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904009923
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License Number State | VA
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