Provider Demographics
NPI:1316950892
Name:HUBBARD, CALLIE B (LCSW)
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:B
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5495 CENTER HILL RD
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-9201
Mailing Address - Country:US
Mailing Address - Phone:901-833-7445
Mailing Address - Fax:901-861-9911
Practice Address - Street 1:5118 PARK AVE
Practice Address - Street 2:SUITE 525
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-5720
Practice Address - Country:US
Practice Address - Phone:901-682-3371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000040191041C0700X
TN1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool