Provider Demographics
NPI:1861509374
Name:HUDGINS, CARMEN LYNN (LAC MENTAL HEALTH WO)
Entity Type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:LYNN
Last Name:HUDGINS
Suffix:
Gender:F
Credentials:LAC MENTAL HEALTH WO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3479
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71656-3479
Mailing Address - Country:US
Mailing Address - Phone:870-403-6034
Mailing Address - Fax:
Practice Address - Street 1:1371 HIGHWAY 278 W
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-9663
Practice Address - Country:US
Practice Address - Phone:870-365-2143
Practice Address - Fax:870-365-2145
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA0607041101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR145879726Medicaid