Healthcare Provider Details

I. General information

NPI: 1629771613
Provider Name (Legal Business Name): BROOKE NICOLE HUTTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3730 WASHINGTON RD STE 200
AUGUSTA GA
30907-4196
US

IV. Provider business mailing address

3730 WASHINGTON RD STE 200
AUGUSTA GA
30907-4196
US

V. Phone/Fax

Practice location:
  • Phone: 706-471-0603
  • Fax: 706-480-6617
Mailing address:
  • Phone: 706-471-0603
  • Fax: 706-480-6617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT002433
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: