Provider Demographics
NPI:1336164334
Name:HUTCHINSON, CONNIE (LMSW)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:HUTCHINSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:M
Other - Last Name:WITUCKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2265 LIVERNOIS RD
Mailing Address - Street 2:260
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1633
Mailing Address - Country:US
Mailing Address - Phone:248-990-6959
Mailing Address - Fax:248-990-6959
Practice Address - Street 1:2265 LIVERNOIS RD
Practice Address - Street 2:260
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1633
Practice Address - Country:US
Practice Address - Phone:248-990-6959
Practice Address - Fax:248-990-6959
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801019442104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIQ26426078Medicare ID - Type Unspecified
MIR66851Medicare UPIN