Healthcare Provider Details

I. General information

NPI: 1346187804
Provider Name (Legal Business Name): SHAKARA T HUTCHINSON BS, MSW, LCSWA, LCAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904 BALDREE RD S
WILSON NC
27893-9509
US

IV. Provider business mailing address

145 STONE RIDGE DR
SMITHFIELD NC
27577-7277
US

V. Phone/Fax

Practice location:
  • Phone: 252-296-8661
  • Fax:
Mailing address:
  • Phone: 252-296-8661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP023590
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: