Provider Demographics
NPI:1740748938
Name:HUTZLER, DONNA J (LCSW)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:J
Last Name:HUTZLER
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 1:5342 MERGANSER CIR
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23061-3648
Mailing Address - Country:US
Mailing Address - Phone:804-694-7143
Mailing Address - Fax:
Practice Address - Street 1:414 ALGONQUIN RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23661-1605
Practice Address - Country:US
Practice Address - Phone:757-722-9881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040069771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0904006977OtherLICENSE