Healthcare Provider Details

I. General information

NPI: 1811285836
Provider Name (Legal Business Name): SYNITA MEQUINN HUDGINS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SYNITA MEQUINN PRYOR LPC

II. Dates (important events)

Enumeration Date: 07/11/2011
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 ATLANTA STREET SE
MARIETTA GA
30060
US

IV. Provider business mailing address

2774 COBB PKWY NW SUITE 109, #379
KENNESAW GA
30152
US

V. Phone/Fax

Practice location:
  • Phone: 470-407-3127
  • Fax:
Mailing address:
  • Phone: 470-407-3127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number004946
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY004326
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPSY004326
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY004326
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY004326
License Number StateGA
# 6
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY004326
License Number StateGA
# 7
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberPSY004326
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: