Provider Demographics
NPI:1174774772
Name:HUDSON, LORRIE JILL (MSW, LICSW)
Entity type:Individual
Prefix:MRS
First Name:LORRIE
Middle Name:JILL
Last Name:HUDSON
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 355K
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25840-9586
Mailing Address - Country:US
Mailing Address - Phone:304-574-1585
Mailing Address - Fax:
Practice Address - Street 1:RR 2 BOX 355K
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:WV
Practice Address - Zip Code:25840-9586
Practice Address - Country:US
Practice Address - Phone:304-574-1585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP039430811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical