Provider Demographics
NPI:1366154031
Name:HUDSON, JILLIAN E (LMHC)
Entity type:Individual
Prefix:MS
First Name:JILLIAN
Middle Name:E
Last Name:HUDSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 MURRELL RD # 138
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4756
Mailing Address - Country:US
Mailing Address - Phone:321-387-7810
Mailing Address - Fax:
Practice Address - Street 1:1211 ADMIRALTY BLVD
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-5201
Practice Address - Country:US
Practice Address - Phone:321-387-7810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-14
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH24755101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health