Provider Demographics
NPI:1750463576
Name:HUTCHINSON, KATHY DIANNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:DIANNE
Last Name:HUTCHINSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:121 HIDALGO DRIVE
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-5978
Mailing Address - Country:US
Mailing Address - Phone:910-907-6999
Mailing Address - Fax:910-907-6571
Practice Address - Street 1:2817 REILLY ROAD MCXC- DSWS
Practice Address - Street 2:WOMACK ARMY MEDICAL CENTER
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-7301
Practice Address - Country:US
Practice Address - Phone:910-907-6999
Practice Address - Fax:910-907-6571
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0046201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ36369AMedicare PIN