Provider Demographics
NPI:1740001569
Name:HUDSON, MARY S
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:S
Last Name:HUDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4397 LAKESHORE CIR
Mailing Address - Street 2:
Mailing Address - City:CATAWBA
Mailing Address - State:NC
Mailing Address - Zip Code:28609-8281
Mailing Address - Country:US
Mailing Address - Phone:828-612-8307
Mailing Address - Fax:
Practice Address - Street 1:4397 LAKESHORE CIR
Practice Address - Street 2:
Practice Address - City:CATAWBA
Practice Address - State:NC
Practice Address - Zip Code:28609-8281
Practice Address - Country:US
Practice Address - Phone:828-612-8307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst