Provider Demographics
NPI:1871932210
Name:HUBBERD, JESSE DOYLE (LCSW)
Entity type:Individual
Prefix:MR
First Name:JESSE
Middle Name:DOYLE
Last Name:HUBBERD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 W DAISY L GATSON BATES DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-5402
Mailing Address - Country:US
Mailing Address - Phone:501-371-9058
Mailing Address - Fax:
Practice Address - Street 1:1020 W DAISY L GATSON BATES DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-5402
Practice Address - Country:US
Practice Address - Phone:501-371-9058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR6941-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical