Provider Demographics
NPI:1932558467
Name:HUDSPETH, EMMA TERRELL (LCSW)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:TERRELL
Last Name:HUDSPETH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:DIANNE
Other - Last Name:TERRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:2808 FOX MEADOW LANE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-9346
Mailing Address - Country:US
Mailing Address - Phone:870-932-4245
Mailing Address - Fax:870-931-4457
Practice Address - Street 1:3704 SOUTH CARAWAY ROAD
Practice Address - Street 2:SUITE 1
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-0754
Practice Address - Country:US
Practice Address - Phone:870-336-0603
Practice Address - Fax:870-336-0598
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7964-C1041C0700X
AR101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR$$$$$$$$$Medicaid