Provider Demographics
NPI:1952047425
Name:HUDSON, DEBORA (LCMHCA)
Entity Type:Individual
Prefix:
First Name:DEBORA
Middle Name:
Last Name:HUDSON
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:956 MEADOWLANDS DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-6025
Mailing Address - Country:US
Mailing Address - Phone:336-471-6224
Mailing Address - Fax:
Practice Address - Street 1:125 ALLEN ST
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-2940
Practice Address - Country:US
Practice Address - Phone:336-283-3830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17430101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health