Provider Demographics
NPI:1629407150
Name:HUDECZ, CARRICE
Entity Type:Individual
Prefix:
First Name:CARRICE
Middle Name:
Last Name:HUDECZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARRICE
Other - Middle Name:
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:355 CHERRY VALLEY DR
Mailing Address - Street 2:APT. Q4
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141-1494
Mailing Address - Country:US
Mailing Address - Phone:317-727-0369
Mailing Address - Fax:
Practice Address - Street 1:355 CHERRY VALLEY DR
Practice Address - Street 2:APT. Q4
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141-1494
Practice Address - Country:US
Practice Address - Phone:317-727-0369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012918101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional