Provider Demographics
NPI:1295073971
Name:HUDSON, COURTNEY BLAKE (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:BLAKE
Last Name:HUDSON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 OVERHILL DR STE 105
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8232
Mailing Address - Country:US
Mailing Address - Phone:704-651-5124
Mailing Address - Fax:704-799-8949
Practice Address - Street 1:125 OVERHILL DR STE 105
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8232
Practice Address - Country:US
Practice Address - Phone:704-651-5124
Practice Address - Fax:704-799-8949
Is Sole Proprietor?:No
Enumeration Date:2013-01-30
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0094461041C0700X
NCP0071611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical