Provider Demographics
NPI:1346062494
Name:HUDSON, CIARRA
Entity type:Individual
Prefix:
First Name:CIARRA
Middle Name:
Last Name:HUDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 STARLING WAY
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-6347
Mailing Address - Country:US
Mailing Address - Phone:321-405-5500
Mailing Address - Fax:
Practice Address - Street 1:1030 SCHOOL AVE
Practice Address - Street 2:
Practice Address - City:PATRICK SPACE FORCE BASE
Practice Address - State:FL
Practice Address - Zip Code:32925
Practice Address - Country:US
Practice Address - Phone:321-405-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-29
Last Update Date:2024-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician