Healthcare Provider Details

I. General information

NPI: 1124235619
Provider Name (Legal Business Name): JULIE MARIE HUTCHINS-WILSON MS, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5451 N UNIVERSITY DR SUITE 102
CORAL SPRINGS FL
33067-4641
US

IV. Provider business mailing address

1504 SW 5TH ST
FT LAUDERDALE FL
33312-7507
US

V. Phone/Fax

Practice location:
  • Phone: 954-227-0551
  • Fax: 954-523-1669
Mailing address:
  • Phone: 954-873-7273
  • Fax: 954-523-1669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMT979
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: