Individual
MS. SHANTIL RENEA HUBBARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA,QP, LCAS-A
Contact information
Practice address
2821 EASTBROOK RD, LYNCHBURG, VA 24501-7701
(434) 258-4136
Mailing address
2505 COURT DR, GASTONIA, NC 28054-2140
(704) 842-6359
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCAS-26865
NC
Other
Enumeration date
11/12/2020
Last updated
11/12/2020
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