Provider Demographics
NPI:1083957567
Name:HUTSON, CARMEN QUEZADA (LCSW)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:QUEZADA
Last Name:HUTSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 MOUNTAIN CREEK RD APT 4A2
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-7217
Mailing Address - Country:US
Mailing Address - Phone:818-238-5599
Mailing Address - Fax:
Practice Address - Street 1:487 MORRISON MOORE PKWY W
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-1422
Practice Address - Country:US
Practice Address - Phone:404-644-8967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0029291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical