Provider Demographics
NPI:1275346090
Name:HUBBARD, WENDY MARLENE (SUDRC)
Entity type:Individual
Prefix:MS
First Name:WENDY
Middle Name:MARLENE
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:SUDRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10308 PEACH AVE
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:93505-3703
Mailing Address - Country:US
Mailing Address - Phone:951-552-5560
Mailing Address - Fax:
Practice Address - Street 1:10308 PEACH AVE
Practice Address - Street 2:
Practice Address - City:CALIFORNIA CITY
Practice Address - State:CA
Practice Address - Zip Code:93505-3703
Practice Address - Country:US
Practice Address - Phone:951-552-5560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18341101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)