Provider Demographics
NPI:1083804744
Name:HUTCHINS, SUE (LADAC)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:HUTCHINS
Suffix:
Gender:F
Credentials:LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 W ALABAMA ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-4604
Mailing Address - Country:US
Mailing Address - Phone:505-526-9002
Mailing Address - Fax:505-526-9110
Practice Address - Street 1:125 WYATT DR
Practice Address - Street 2:B
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2924
Practice Address - Country:US
Practice Address - Phone:505-526-9002
Practice Address - Fax:505-526-9110
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0105961101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)