Provider Demographics
NPI:1811285836
Name:HUDGINS, SYNITA MEQUINN (PHD)
Entity type:Individual
Prefix:
First Name:SYNITA
Middle Name:MEQUINN
Last Name:HUDGINS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:SYNITA
Other - Middle Name:MEQUINN
Other - Last Name:PRYOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:2774 COBB PKWY NW
Mailing Address - Street 2:SUITE 109, #379
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152
Mailing Address - Country:US
Mailing Address - Phone:470-407-3127
Mailing Address - Fax:
Practice Address - Street 1:55 ATLANTA STREET SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060
Practice Address - Country:US
Practice Address - Phone:470-407-3127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-11
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004946101YP2500X
GAPSY004326103T00000X, 103TA0400X, 103TB0200X, 103TC0700X, 103TF0200X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service