Provider Demographics
NPI:1609634278
Name:CLARK J. HUDAK, JR., PHD, LCSW-C
Entity Type:Organization
Organization Name:CLARK J. HUDAK, JR., PHD, LCSW-C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HUDAK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:443-790-8228
Mailing Address - Street 1:11426 BARROW DOWNS
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-1006
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11426 BARROW DOWNS
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-1006
Practice Address - Country:US
Practice Address - Phone:443-790-8228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty