Provider Demographics
NPI:1164762076
Name:HUDSON, PHYLANDRIA LASHAY (LCSW)
Entity Type:Individual
Prefix:
First Name:PHYLANDRIA
Middle Name:LASHAY
Last Name:HUDSON
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 1:1618 PEAR ORCHARD PL
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-2206
Mailing Address - Country:US
Mailing Address - Phone:601-942-1129
Mailing Address - Fax:
Practice Address - Street 1:1618 PEAR ORCHARD PL
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-2206
Practice Address - Country:US
Practice Address - Phone:601-942-1129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC-58321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical