MEDICARE: MRS. CASSANDRE ELENA DUJOUR HUDSON LCSW

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	1041C0700X	Clinical Social Worker	CSW007539

General Provider Information

NPI Number	:	1487328050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CASSANDRE ELENA DUJOUR HUDSON LCSW

Provider Business Mailing Address
First Line	:	2032 HATTON CT
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-9834
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4408 COLUMBIA RD STE 104
Second Line	:
City	:	MARTINEZ
State	:	GA
Zip	:	30907-4561
Country	:	US
Telephone Number	:	706-310-5153
Fax Number	:

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

Provider Enumeration Date	:	08/05/2021
Last Update Date	:	05/21/2022

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