Provider Demographics
NPI:1831344548
Name:HUTCHINSON, BONITA GRISSETTE (LPC, LCMHC-S, LCAS)
Entity type:Individual
Prefix:MS
First Name:BONITA
Middle Name:GRISSETTE
Last Name:HUTCHINSON
Suffix:
Gender:F
Credentials:LPC, LCMHC-S, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5009 BEATTIES FORD RD STE 107-233
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-2859
Mailing Address - Country:US
Mailing Address - Phone:980-533-5839
Mailing Address - Fax:
Practice Address - Street 1:5200 PARK RD STE 218
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3673
Practice Address - Country:US
Practice Address - Phone:980-533-5839
Practice Address - Fax:980-939-6423
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-21
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARA8620417101YA0400X
NC2313101YA0400X
NC7953101YM0800X
NCS7953101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health