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General NPI Number Information
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NPI Number | 1528566700
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Entity Type | Individual
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Provider Name | RENEE YVONNE HUDSON RADT1
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Gender | Female
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Dates
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Enumeration Date | 01/23/2018
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Last Update Date | 06/17/2019
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Provider Practice Location Address
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Address Line | 2100 CAPITOL AVE
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City | SACRAMENTO
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State | CA
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Zip | 95816-5721
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Country | US
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Telephone | 916-442-4985
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Fax |
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Provider Business Mailing Address
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Address Line | 3990 INDUSTRIAL BLVD
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City | WEST SACRAMENTO
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State | CA
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Zip | 95691-3430
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Country | US
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Telephone | 916-391-4293
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | R1253110617
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License Number State | CA
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