Provider Demographics
NPI:1447090667
Name:HUBBARD, STACEY A (PEER RECOVERY)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:A
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:PEER RECOVERY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 BEAUMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-4312
Mailing Address - Country:US
Mailing Address - Phone:410-622-2442
Mailing Address - Fax:
Practice Address - Street 1:700 BEAUMONT AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-4312
Practice Address - Country:US
Practice Address - Phone:410-622-2442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDPR0947101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)