Hudson, Clifton Robert

Hudson, Clifton Robert is an sole proprietor health care provider with primary practice located at 515 3Rd Ave Suite 100, South Charleston WV 25303-1329. He recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Psychologist, Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Forensic. Behavioral Health & Social Service Providers / Clinical is his primary health care specialty. Hudson, Clifton Robert can be contacted via phone (304) 415-2299.

Contact Information

Primary practice address
515 3Rd Ave Suite 100 South Charleston WV 25303-1329
Phone: (304) 415-2299
Fax: (800) 983-2875
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X 908 West Virginia
Behavioral Health & Social Service Providers / Clinical 103TC0700X 908 West Virginia
Behavioral Health & Social Service Providers / Forensic 103TF0200X 908 West Virginia

Profile Details

NPI number 1962413567
LBN Legal business name Hudson, Clifton Robert
Credentials PHD
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 10th, 2006
Last updated Sep 30th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1962413567 NPPES
West Virginia MEDICAID 3810002673

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