Provider Demographics
NPI:1467926741
Name:HUDSON, MILES H III (LICSW, PIP)
Entity Type:Individual
Prefix:MR
First Name:MILES
Middle Name:H
Last Name:HUDSON
Suffix:III
Gender:M
Credentials:LICSW, PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2457 OLD BRIAR TRL
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35226-1526
Mailing Address - Country:US
Mailing Address - Phone:205-447-6155
Mailing Address - Fax:
Practice Address - Street 1:2109 DARLINGTON ST
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35226-3007
Practice Address - Country:US
Practice Address - Phone:205-447-6155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-19
Last Update Date:2019-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4138C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical