Provider Demographics
NPI:1104959592
Name:HUDSON, NAKEIA L (LISW-S)
Entity type:Individual
Prefix:
First Name:NAKEIA
Middle Name:L
Last Name:HUDSON
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E CAMPUS VIEW BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-4678
Mailing Address - Country:US
Mailing Address - Phone:614-259-8879
Mailing Address - Fax:614-413-1537
Practice Address - Street 1:200 E CAMPUS VIEW BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-4678
Practice Address - Country:US
Practice Address - Phone:614-259-8879
Practice Address - Fax:614-413-1537
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0700419-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH08258Medicare UPIN