Provider Demographics
NPI:1760911127
Name:HUTCHINSON, WILLIE MARVIN
Entity Type:Individual
Prefix:
First Name:WILLIE
Middle Name:MARVIN
Last Name:HUTCHINSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 HIGHVIEW CT
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:PA
Mailing Address - Zip Code:19560-1673
Mailing Address - Country:US
Mailing Address - Phone:610-451-6089
Mailing Address - Fax:
Practice Address - Street 1:1017 HIGHVIEW COURT
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:PA
Practice Address - Zip Code:19560
Practice Address - Country:US
Practice Address - Phone:610-451-6089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health