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General NPI Number Information
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NPI Number | 1801359310
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Entity Type | Individual
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Provider Name | TIARA CHANTE HUDSON MSW, LCSW, LISW
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Gender | Female
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Dates
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Enumeration Date | 04/11/2019
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Last Update Date | 10/10/2022
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Provider Practice Location Address
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Address Line | 1706 W GILLIGAN AVE
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City | ROGERS
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State | AR
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Zip | 72758-5500
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Country | US
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Telephone | 479-323-1172
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Fax |
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Provider Business Mailing Address
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Address Line | 100 N DIXIELAND RD STE D2 BOX 326
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City | ROGERS
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State | AR
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Zip | 72756-1123
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Country | US
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Telephone | 479-323-1172
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW0006558
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 114405
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2022024976
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License Number State | MO
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 10412-C
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License Number State | AR
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