Provider Demographics
NPI:1528566700
Name:HUDSON, RENEE YVONNE (RADT1)
Entity Type:Individual
Prefix:MISS
First Name:RENEE
Middle Name:YVONNE
Last Name:HUDSON
Suffix:
Gender:F
Credentials:RADT1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3990 INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-3430
Mailing Address - Country:US
Mailing Address - Phone:916-391-4293
Mailing Address - Fax:
Practice Address - Street 1:2100 CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5721
Practice Address - Country:US
Practice Address - Phone:916-442-4985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1253110617101YA0400X
CAR1215130915101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR1253110617OtherCCAPP