Provider Demographics
NPI:1114564341
Name:HUDSON, DENITA NICOLE (PHD, LMHCA)
Entity Type:Individual
Prefix:DR
First Name:DENITA
Middle Name:NICOLE
Last Name:HUDSON
Suffix:
Gender:F
Credentials:PHD, LMHCA
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 33
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45315-0033
Mailing Address - Country:US
Mailing Address - Phone:937-750-4463
Mailing Address - Fax:317-471-8994
Practice Address - Street 1:3500 DEPAUW BLVD STE 1050
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-6125
Practice Address - Country:US
Practice Address - Phone:317-471-8996
Practice Address - Fax:317-471-8994
Is Sole Proprietor?:No
Enumeration Date:2019-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0007487101YP2500X
IN88000873A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional