Healthcare Provider Details

I. General information

NPI: 1336164334
Provider Name (Legal Business Name): CONNIE HUTCHINSON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CONNIE M WITUCKI

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 11/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2265 LIVERNOIS RD 260
TROY MI
48083-1633
US

IV. Provider business mailing address

2265 LIVERNOIS RD 260
TROY MI
48083-1633
US

V. Phone/Fax

Practice location:
  • Phone: 248-990-6959
  • Fax: 248-990-6959
Mailing address:
  • Phone: 248-990-6959
  • Fax: 248-990-6959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801019442
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: