MEDICARE: LORI STUBBS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1588411052
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LORI STUBBS LLC

Provider Business Mailing Address
First Line	:	2410 BEMISS RD STE D
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31602-4827
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	411 UNIVERSITY DR
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31602-1803
Country	:	US
Telephone Number	:	229-259-6730
Fax Number	:

Authorized Official
Title or Position	:	LCSW
Name	:	LORI STUBBS
Credential	:
Telephone Number	:	229-221-3442

Provider Enumeration Date	:	05/02/2024
Last Update Date	:	12/02/2025

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