Individual
TANA HUDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LISW
Contact information
Practice address
1202 HIGHWAY 60, BUILDING D, SOCORRO, NM 87801-3914
(575) 838-4690
(575) 838-4689
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
I-08462
NM
Other
Enumeration date
01/11/2012
Last updated
04/08/2016
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