Provider Demographics
NPI:1740864651
Name:HUDSON, CHAUNCEY JOHNSON (LICSW)
Entity type:Individual
Prefix:
First Name:CHAUNCEY
Middle Name:JOHNSON
Last Name:HUDSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 19TH ST N STE 265
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35203-3227
Mailing Address - Country:US
Mailing Address - Phone:205-546-8265
Mailing Address - Fax:
Practice Address - Street 1:120 19TH ST N STE 265
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35203-3227
Practice Address - Country:US
Practice Address - Phone:205-546-8265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-06
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5111G104100000X
AL5249C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker