Provider Demographics
NPI:1730459405
Name:S J HUDSON THERAPEUTIC SERVICES
Entity type:Organization
Organization Name:S J HUDSON THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:313-422-3213
Mailing Address - Street 1:8813 WOODLAWN ST
Mailing Address - Street 2:8813 WOODLAWN
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48213-1132
Mailing Address - Country:US
Mailing Address - Phone:313-422-3213
Mailing Address - Fax:
Practice Address - Street 1:8813 WOODLAWN ST
Practice Address - Street 2:8813 WOODLAWN
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48213-1132
Practice Address - Country:US
Practice Address - Phone:313-422-3213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801081790251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health