Healthcare Provider Details

I. General information

NPI: 1346286531
Provider Name (Legal Business Name): JIM HARVEY HUTCHESON PHD LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2214 DEVINE STREET
COLUMBIA SC
29205
US

IV. Provider business mailing address

PO BOX 5535
COLUMBIA SC
29250
US

V. Phone/Fax

Practice location:
  • Phone: 803-806-8409
  • Fax:
Mailing address:
  • Phone: 803-806-8409
  • Fax: 803-806-8476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1349
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: