Healthcare Provider Details

I. General information

NPI: 1982286795
Provider Name (Legal Business Name): HEATHER DIANE HUDGINS MS, LCADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 MEMORIAL PKWY
PHILLIPSBURG NJ
08865-1580
US

IV. Provider business mailing address

370 MEMORIAL PKWY
PHILLIPSBURG NJ
08865-1580
US

V. Phone/Fax

Practice location:
  • Phone: 908-454-4470
  • Fax: 908-454-5317
Mailing address:
  • Phone: 908-454-4470
  • Fax: 908-454-5317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00280100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: