Provider Demographics
NPI:1861055022
Name:STUBBS, KATAYA A (LMSW)
Entity type:Individual
Prefix:MISS
First Name:KATAYA
Middle Name:A
Last Name:STUBBS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3811
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70821-3811
Mailing Address - Country:US
Mailing Address - Phone:225-803-8503
Mailing Address - Fax:
Practice Address - Street 1:14635 S HARRELLS FERRY RD STE 3A
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-2960
Practice Address - Country:US
Practice Address - Phone:225-803-8503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2024-04-03
Deactivation Date:2020-12-29
Deactivation Code:
Reactivation Date:2023-07-13
Provider Licenses
StateLicense IDTaxonomies
171M00000X
LA15197104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator