Provider Demographics
NPI:1144060856
Name:HUDNALL, RENEE DIANA (MA, RIC)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:DIANA
Last Name:HUDNALL
Suffix:
Gender:F
Credentials:MA, RIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 RICKETTS DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-3676
Mailing Address - Country:US
Mailing Address - Phone:540-535-1112
Mailing Address - Fax:
Practice Address - Street 1:36 RICKETTS DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3676
Practice Address - Country:US
Practice Address - Phone:540-535-1112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704016634101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health