Provider Demographics
NPI:1306396130
Name:HUDSON, DONALD (PHD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:HUDSON
Suffix:
Gender:M
Credentials:PHD
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 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-316-7585
Mailing Address - Fax:
Practice Address - Street 1:584 HOSPITAL DR NE
Practice Address - Street 2:SUITE A
Practice Address - City:BOLIVIA
Practice Address - State:NC
Practice Address - Zip Code:28422-0019
Practice Address - Country:US
Practice Address - Phone:704-316-7585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4946103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist