Provider Demographics
NPI:1699248559
Name:HUDGINS-SMITH, KHIA LADAWN (MA)
Entity type:Individual
Prefix:
First Name:KHIA
Middle Name:LADAWN
Last Name:HUDGINS-SMITH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 STANLEY AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-4434
Mailing Address - Country:US
Mailing Address - Phone:423-946-4753
Mailing Address - Fax:
Practice Address - Street 1:2700 S ROAN ST STE 410
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-7638
Practice Address - Country:US
Practice Address - Phone:423-408-8041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor