Provider Demographics
NPI:1386668168
Name:HUDSON, THOMAS ROSS (LPC)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:ROSS
Last Name:HUDSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9851 BUSINESS WAY
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4152
Mailing Address - Country:US
Mailing Address - Phone:703-257-7070
Mailing Address - Fax:703-335-1355
Practice Address - Street 1:9851 BUSINESS WAY
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4152
Practice Address - Country:US
Practice Address - Phone:703-257-7070
Practice Address - Fax:703-335-1355
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002512101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5411131Medicaid
VA8871701Medicare ID - Type UnspecifiedCROSS OVER NUMBER