Provider Demographics
NPI:1144385865
Name:HUTTO, GINA KEMP (LPC, MAC)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:KEMP
Last Name:HUTTO
Suffix:
Gender:F
Credentials:LPC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2823 CLAUDE BREWER RD
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-4203
Mailing Address - Country:US
Mailing Address - Phone:404-557-1110
Mailing Address - Fax:770-918-6686
Practice Address - Street 1:977A TAYLOR ST SW
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-5357
Practice Address - Country:US
Practice Address - Phone:770-918-6677
Practice Address - Fax:770-918-6686
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003021101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional