Healthcare Provider Details

I. General information

NPI: 1164999777
Provider Name (Legal Business Name): MERCEDES HUTCH THOMPSON CADCT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2018
Last Update Date: 11/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 STONEWALL ST
CARTERSVILLE GA
30120-3628
US

IV. Provider business mailing address

408 MOUNTAIN CHASE
CARTERSVILLE GA
30120-8519
US

V. Phone/Fax

Practice location:
  • Phone: 770-386-1907
  • Fax: 770-386-7345
Mailing address:
  • Phone: 678-396-2711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: