Healthcare Provider Details

I. General information

NPI: 1801150222
Provider Name (Legal Business Name): KIMBERLY ELLEN HUTCHINS LPCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 06/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4276 LEGEND AVE STE C
FAYETTEVILLE NC
28303-3497
US

IV. Provider business mailing address

4267- C LEGEND AVENUE
FAYETTEVILLE NC
28303
US

V. Phone/Fax

Practice location:
  • Phone: 910-485-6843
  • Fax:
Mailing address:
  • Phone: 910-485-6843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberA9199
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: