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General NPI Number Information
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NPI Number | 1730459405
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Entity Type | Organization
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Legal Business Name | S J HUDSON THERAPEUTIC SERVICES
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Dates
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Enumeration Date | 01/11/2012
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Last Update Date | 01/11/2012
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Provider Practice Location Address
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Address Line | 8813 WOODLAWN ST 8813 WOODLAWN
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City | DETROIT
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State | MI
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Zip | 48213-1132
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Country | US
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Telephone | 313-422-3213
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Fax |
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Provider Business Mailing Address
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Address Line | 8813 WOODLAWN ST 8813 WOODLAWN
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City | DETROIT
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State | MI
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Zip | 48213-1132
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Country | US
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Telephone | 313-422-3213
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | SHIRLEY JEAN HUDSON
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Credential | LMSW
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Telephone | 313-422-3213
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6801081790
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License Number State | MI
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