Provider Demographics
NPI:1831976075
Name:HUTCHERSON, JAMAL ANTIONE
Entity type:Individual
Prefix:
First Name:JAMAL
Middle Name:ANTIONE
Last Name:HUTCHERSON
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 1:6000 CORTADERIA ST NE APT 5104
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-8007
Mailing Address - Country:US
Mailing Address - Phone:469-245-4597
Mailing Address - Fax:
Practice Address - Street 1:6000 CORTADERIA ST NE APT 5104
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-8007
Practice Address - Country:US
Practice Address - Phone:469-245-4597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician