Healthcare Provider Details

I. General information

NPI: 1780768572
Provider Name (Legal Business Name): BARBIE J HUDSON PCC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 09/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 GREENWOOD LN
SPRINGBORO OH
45066-3033
US

IV. Provider business mailing address

204 COOK RD SUITE 400
LEBANON OH
45036-9600
US

V. Phone/Fax

Practice location:
  • Phone: 937-746-1154
  • Fax: 937-746-8523
Mailing address:
  • Phone: 513-228-7800
  • Fax: 513-695-2952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberE-0500520-SUPV
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE-0500520-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: