Provider Demographics
NPI:1255092581
Name:HUDSON, SHANAE (LCSW, LICSW, LISW-CP)
Entity type:Individual
Prefix:
First Name:SHANAE
Middle Name:
Last Name:HUDSON
Suffix:
Gender:F
Credentials:LCSW, LICSW, LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1348 EISENHOWER DR UNIT 16192
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-7817
Mailing Address - Country:US
Mailing Address - Phone:202-730-8996
Mailing Address - Fax:
Practice Address - Street 1:121 GLEN OAKS DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-2761
Practice Address - Country:US
Practice Address - Phone:202-730-8996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-08
Last Update Date:2022-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC134561041C0700X
DCLC500826401041C0700X
GACSW0069501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical