Provider Demographics
NPI:1336522689
Name:JUDD, MICHAEL WILSON (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WILSON
Last Name:JUDD
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 FULLER LN
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28805-9721
Mailing Address - Country:US
Mailing Address - Phone:419-283-0576
Mailing Address - Fax:
Practice Address - Street 1:11 FULLER LN
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805-9721
Practice Address - Country:US
Practice Address - Phone:419-283-0576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-06
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5341103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist