Provider Demographics
NPI:1366865743
Name:HUTTO, KOTINA TARHESHE (LPC)
Entity Type:Individual
Prefix:
First Name:KOTINA
Middle Name:TARHESHE
Last Name:HUTTO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2712 MIDDLEBURG DR
Mailing Address - Street 2:SUITE 207-B
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2415
Mailing Address - Country:US
Mailing Address - Phone:803-556-9439
Mailing Address - Fax:803-419-7497
Practice Address - Street 1:2712 MIDDLEBURG DR
Practice Address - Street 2:SUITE 207-B
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2415
Practice Address - Country:US
Practice Address - Phone:803-556-9439
Practice Address - Fax:803-419-7497
Is Sole Proprietor?:No
Enumeration Date:2014-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5631101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional