Healthcare Provider Details

I. General information

NPI: 1114377736
Provider Name (Legal Business Name): KAMIE HUTCHINS LICDC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 07/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 E GAMBIER ST
MOUNT VERNON OH
43050
US

IV. Provider business mailing address

106 E GAMBIER ST
MOUNT VERNON OH
43050-3510
US

V. Phone/Fax

Practice location:
  • Phone: 740-397-2660
  • Fax:
Mailing address:
  • Phone: 740-397-2660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.161630
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1801909
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: