Provider Demographics
NPI:1588193296
Name:HUDSON, CHRISTINE L (CADC II/CRM II)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:L
Last Name:HUDSON
Suffix:
Gender:F
Credentials:CADC II/CRM II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1776 SW MADISON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-1715
Mailing Address - Country:US
Mailing Address - Phone:971-386-2278
Mailing Address - Fax:503-224-4494
Practice Address - Street 1:620 NE 2ND ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7514
Practice Address - Country:US
Practice Address - Phone:503-224-1044
Practice Address - Fax:503-621-2235
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23-CRM-II-0107101YA0400X
OR23-08-20307101YA0400X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500760166Medicaid
OR500729752Medicaid
OR500729752Medicaid