Provider Demographics
NPI:1497165328
Name:HUTCHENS, JACQUELYN DENISE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JACQUELYN
Middle Name:DENISE
Last Name:HUTCHENS
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 1:115 FRED CT
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-8316
Mailing Address - Country:US
Mailing Address - Phone:706-951-6786
Mailing Address - Fax:
Practice Address - Street 1:115 FRED CT
Practice Address - Street 2:
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813-8316
Practice Address - Country:US
Practice Address - Phone:706-951-6786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55036104100000X
DEQ1-00012201041C0700X
GACSW0051101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker