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General NPI Number Information
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NPI Number | 1962929471
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Entity Type | Individual
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Provider Name | MARESA SHERYL HUBBARD LCSW, LAC
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Gender | Female
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Dates
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Enumeration Date | 08/25/2017
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 1355 S COLORADO BLVD STE C100
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City | DENVER
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State | CO
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Zip | 80222-3358
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Country | US
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Telephone | 720-282-9381
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Fax |
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Provider Business Mailing Address
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Address Line | 19468 E 62ND AVE
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City | AURORA
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State | CO
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Zip | 80019-2136
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Country | US
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Telephone | 720-288-1275
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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 | ACD.0001654
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License Number State | CO
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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 | CSW.09931175
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License Number State | CO
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