Healthcare Provider Details

I. General information

NPI: 1164923348
Provider Name (Legal Business Name): JOY R HUDSON LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2018
Last Update Date: 12/20/2019
Certification Date: 12/20/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 VARNUM ST NE
WASHINGTON DC
20017-2180
US

IV. Provider business mailing address

1150 VARNUM ST NE ST CATHERINES HALL, ROOM 102
WASHINGTON DC
20017-2180
US

V. Phone/Fax

Practice location:
  • Phone: 202-854-7623
  • Fax: 202-854-7616
Mailing address:
  • Phone: 202-854-4069
  • Fax: 202-854-7825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11037
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50081731
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: