Healthcare Provider Details

I. General information

NPI: 1073902938
Provider Name (Legal Business Name): TIMOTHY CHARLES HUTCHINSON JR. LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2015
Last Update Date: 02/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

437 W PARKER ST
BAXLEY GA
31513
US

IV. Provider business mailing address

437 W PARKER ST
BAXLEY GA
31513-0605
US

V. Phone/Fax

Practice location:
  • Phone: 912-705-0858
  • Fax: 912-705-6423
Mailing address:
  • Phone: 912-705-0858
  • Fax: 912-705-6423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC008226
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: