Provider Demographics
NPI:1225456635
Name:CONNIE M HUTCHINSON LMSW ACSW LLC
Entity Type:Organization
Organization Name:CONNIE M HUTCHINSON LMSW ACSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUTCHINSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:248-990-6959
Mailing Address - Street 1:2265 LIVERNOIS RD
Mailing Address - Street 2:STE 260
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1633
Mailing Address - Country:US
Mailing Address - Phone:248-990-6959
Mailing Address - Fax:
Practice Address - Street 1:2265 LIVERNOIS RD
Practice Address - Street 2:STE 260
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1633
Practice Address - Country:US
Practice Address - Phone:248-990-6959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-02
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010194421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty