Provider Demographics
NPI:1174254734
Name:HUDSON-THOMPSON, TRACY-ANN NATOYA
Entity Type:Individual
Prefix:MRS
First Name:TRACY-ANN
Middle Name:NATOYA
Last Name:HUDSON-THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2729 THURSBY CROSS
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-2897
Mailing Address - Country:US
Mailing Address - Phone:954-549-5582
Mailing Address - Fax:
Practice Address - Street 1:753 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-3238
Practice Address - Country:US
Practice Address - Phone:910-490-2037
Practice Address - Fax:910-479-1711
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-23
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0195151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical