Provider Demographics
NPI:1801359310
Name:HUDSON, TIARA CHANTE (MSW, LCSW, LISW)
Entity Type:Individual
Prefix:MS
First Name:TIARA
Middle Name:CHANTE
Last Name:HUDSON
Suffix:
Gender:F
Credentials:MSW, LCSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N DIXIELAND RD STE D2
Mailing Address - Street 2:BOX 326
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-1123
Mailing Address - Country:US
Mailing Address - Phone:479-323-1172
Mailing Address - Fax:
Practice Address - Street 1:1706 W GILLIGAN AVE
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-5500
Practice Address - Country:US
Practice Address - Phone:479-323-1172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-11
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW00065581041C0700X
IA1144051041C0700X
MO20220249761041C0700X
AR10412-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical