Provider Demographics
NPI:1346514288
Name:HUDSON HARRIS, GLENETTA (PHD)
Entity type:Individual
Prefix:DR
First Name:GLENETTA
Middle Name:
Last Name:HUDSON HARRIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:847 QUINCE ORCHARD BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-1677
Mailing Address - Country:US
Mailing Address - Phone:301-836-1426
Mailing Address - Fax:301-263-7710
Practice Address - Street 1:847 QUINCE ORCHARD BLVD STE E
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-1677
Practice Address - Country:US
Practice Address - Phone:301-836-1426
Practice Address - Fax:301-263-7710
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04885103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical