Healthcare Provider Details

I. General information

NPI: 1700313137
Provider Name (Legal Business Name): HANNAH HUDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2017
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1529 SAM RITTENBERG BLVD STE 1B
CHARLESTON SC
29407-4125
US

IV. Provider business mailing address

1674 FOLLY RD APT 302
CHARLESTON SC
29412-8708
US

V. Phone/Fax

Practice location:
  • Phone: 803-550-6924
  • Fax:
Mailing address:
  • Phone: 410-507-0380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: