MEDICARE: JEREMY D HUDSON MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	A20743	NC

General Provider Information

NPI Number	:	1295558450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY D HUDSON MA

Provider Business Mailing Address
First Line	:	190 ROSEWOOD CENTRE DR STE 100
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-7628
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5524 REX RD
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-9728
Country	:	US
Telephone Number	:	919-601-6737
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2024
Last Update Date	:	11/06/2024

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