Provider Demographics
NPI:1962699702
Name:HUBBERT, PAULETTE DENISE (LCSW,CSAC)
Entity type:Individual
Prefix:DR
First Name:PAULETTE
Middle Name:DENISE
Last Name:HUBBERT
Suffix:
Gender:F
Credentials:LCSW,CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15107 LEICESTERSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-6545
Mailing Address - Country:US
Mailing Address - Phone:816-785-3876
Mailing Address - Fax:
Practice Address - Street 1:211 N UNION ST STE 100
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2643
Practice Address - Country:US
Practice Address - Phone:703-672-0393
Practice Address - Fax:855-282-5282
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
MO20050045781041C0700X
VA09040099231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty