Provider Demographics
NPI:1972842987
Name:HUDSON, SARA (LICSW, LCSW)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:HUDSON
Suffix:
Gender:F
Credentials:LICSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17015 WINGED THISTLE CT
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-7837
Mailing Address - Country:US
Mailing Address - Phone:704-488-5632
Mailing Address - Fax:
Practice Address - Street 1:17015 WINGED THISTLE CT
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-7837
Practice Address - Country:US
Practice Address - Phone:704-488-5632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-11
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MA1184231041C0700X, 104100000X
NCC0153861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker