Healthcare Provider Details

I. General information

NPI: 1093226136
Provider Name (Legal Business Name): KATIE HUTCHINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2017
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1541 WESTBROOK PLAZA DR
WINSTON SALEM NC
27103-1329
US

IV. Provider business mailing address

4407 STEPHENS FARM LN
KERNERSVILLE NC
27284-0073
US

V. Phone/Fax

Practice location:
  • Phone: 980-785-1113
  • Fax: 980-785-1114
Mailing address:
  • Phone: 336-253-7399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2854012
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: