Provider Demographics
NPI:1336407246
Name:HUDSPETH, WILLIAM R (LCSW, CSAC/CCJP, SAP)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:R
Last Name:HUDSPETH
Suffix:
Gender:M
Credentials:LCSW, CSAC/CCJP, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1364 ONIONI ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-3755
Mailing Address - Country:US
Mailing Address - Phone:808-392-2570
Mailing Address - Fax:
Practice Address - Street 1:42-477 KALANIANAOLE HWY
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-4302
Practice Address - Country:US
Practice Address - Phone:808-266-9922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-27
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI19871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical