Healthcare Provider Details

I. General information

NPI: 1962946848
Provider Name (Legal Business Name): SARAH MICHELLE HUDSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2016
Last Update Date: 04/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 ENTERPRISE DR STE 300
LOWELL AR
72745-8982
US

IV. Provider business mailing address

515 ENTERPRISE DR STE 300
LOWELL AR
72745-8982
US

V. Phone/Fax

Practice location:
  • Phone: 479-717-7643
  • Fax: 479-717-7627
Mailing address:
  • Phone: 479-717-7643
  • Fax: 479-717-7627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6616-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: