Provider Demographics
NPI:1023767233
Name:HUDSON, DORIEN DUSHONE SR
Entity type:Individual
Prefix:
First Name:DORIEN
Middle Name:DUSHONE
Last Name:HUDSON
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24451 LAKE SHORE BLVD # 2-616
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-1272
Mailing Address - Country:US
Mailing Address - Phone:216-387-5333
Mailing Address - Fax:
Practice Address - Street 1:24451 LAKE SHORE BLVD # 2-616
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-1272
Practice Address - Country:US
Practice Address - Phone:216-387-5333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-23
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1023767233171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator