Provider Demographics
NPI:1386226025
Name:HUBBARD, NIYA EUNICE (MSW, MED)
Entity type:Individual
Prefix:MS
First Name:NIYA
Middle Name:EUNICE
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:MSW, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375B CROSS CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-3729
Mailing Address - Country:US
Mailing Address - Phone:850-942-6222
Mailing Address - Fax:
Practice Address - Street 1:1375B CROSS CREEK CIR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-3729
Practice Address - Country:US
Practice Address - Phone:850-942-6222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-22
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 174H00000X, 104100000X
FLISW12007101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174H00000XOther Service ProvidersHealth Educator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker