Provider Demographics
NPI:1083454680
Name:HUDSON, CIERRA MICHELLE (RBT)
Entity type:Individual
Prefix:
First Name:CIERRA
Middle Name:MICHELLE
Last Name:HUDSON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:CIERRA
Other - Middle Name:MICHELLE
Other - Last Name:RUPERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:440 ROPER MOUNTAIN RD STE A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4235
Mailing Address - Country:US
Mailing Address - Phone:864-256-4067
Mailing Address - Fax:
Practice Address - Street 1:440 ROPER MOUNTAIN RD STE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4235
Practice Address - Country:US
Practice Address - Phone:864-256-4067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-21-197296106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician