MEDICARE: MRS. SANDRA BECKFORD HUTCHISON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C004765	NC

General Provider Information

NPI Number	:	1730223025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SANDRA BECKFORD HUTCHISON LCSW

Provider Business Mailing Address
First Line	:	1913 J N PEASE PL STE 104
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-4537
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1913 J N PEASE PL STE 104
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-4537
Country	:	US
Telephone Number	:	704-549-3993
Fax Number	:	704-248-2901

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	01/28/2011

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