Healthcare Provider Details

I. General information

NPI: 1174669964
Provider Name (Legal Business Name): RACHELLE DINET HUTCHINSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 02/10/2020
Certification Date: 02/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2775 CRUSE RD STE 901
LAWRENCEVILLE GA
30044-7143
US

IV. Provider business mailing address

2775 CRUSE RD STE 2601
LAWRENCEVILLE GA
30044-7148
US

V. Phone/Fax

Practice location:
  • Phone: 770-925-2095
  • Fax: 866-468-1886
Mailing address:
  • Phone: 770-925-2095
  • Fax: 770-277-0773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCSW003550
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: