Provider Demographics
NPI:1386980787
Name:STUBBS, ANDREA L (LCSW)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:STUBBS
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 1:2416 GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-4112
Mailing Address - Country:US
Mailing Address - Phone:919-602-8228
Mailing Address - Fax:833-900-1747
Practice Address - Street 1:8601 SIX FORKS RD STE 400
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-2965
Practice Address - Country:US
Practice Address - Phone:919-855-4232
Practice Address - Fax:833-900-1747
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-13
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0074421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical