Provider Demographics
NPI:1689863151
Name:HUDSON, DIANE GENEVA (LMFT)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:GENEVA
Last Name:HUDSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 ARCHWOOD DR SW
Mailing Address - Street 2:#366
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-5641
Mailing Address - Country:US
Mailing Address - Phone:253-223-9143
Mailing Address - Fax:
Practice Address - Street 1:1111 ARCHWOOD DR SW
Practice Address - Street 2:#366
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5641
Practice Address - Country:US
Practice Address - Phone:253-223-9143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00002141106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALF00002141OtherDEPARTMENT OF HEALTH