Provider Demographics
NPI:1871103192
Name:STUBBS, LORI ALLISON (LCSW)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:ALLISON
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 1:411 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1803
Mailing Address - Country:US
Mailing Address - Phone:229-472-0901
Mailing Address - Fax:
Practice Address - Street 1:319 N STEVENS ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-5464
Practice Address - Country:US
Practice Address - Phone:229-221-3442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-01
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0090831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical