Provider Demographics
NPI:1578162137
Name:HUDSON, TODD B (MS)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:B
Last Name:HUDSON
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4114 ROYAL REGENCY CIR NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-6478
Mailing Address - Country:US
Mailing Address - Phone:404-578-3145
Mailing Address - Fax:
Practice Address - Street 1:1301 SHILOH RD NW STE 710
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7157
Practice Address - Country:US
Practice Address - Phone:404-578-3145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health