Provider Demographics
NPI:1700462488
Name:DUDLEY, KANIYA (RSW)
Entity Type:Individual
Prefix:
First Name:KANIYA
Middle Name:
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:RSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 CARTER ST
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:LA
Mailing Address - Zip Code:71373-3115
Mailing Address - Country:US
Mailing Address - Phone:318-336-4797
Mailing Address - Fax:
Practice Address - Street 1:1810 CARTER ST
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:LA
Practice Address - Zip Code:71373-3115
Practice Address - Country:US
Practice Address - Phone:318-336-4797
Practice Address - Fax:318-336-4799
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16421104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker