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General NPI Number Information
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NPI Number | 1639616071
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Entity Type | Individual
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Provider Name | SHAREE ALISHA HUDSON
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Gender | Female
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Dates
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Enumeration Date | 01/24/2017
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Last Update Date | 05/07/2024
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Provider Practice Location Address
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Address Line | 20311 CENTRAL AVE W
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City | BLOUNTSTOWN
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State | FL
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Zip | 32424-1947
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Country | US
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Telephone | 850-674-8888
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Fax |
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Provider Business Mailing Address
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Address Line | 6901 NW DANNY BLACK RD
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City | BRISTOL
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State | FL
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Zip | 32321-2407
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Country | US
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Telephone | 850-518-0249
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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