Healthcare Provider Details

I. General information

NPI: 1366865743
Provider Name (Legal Business Name): KOTINA TARHESHE HUTTO LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2014
Last Update Date: 01/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2712 MIDDLEBURG DR SUITE 207-B
COLUMBIA SC
29204-2415
US

IV. Provider business mailing address

2712 MIDDLEBURG DR SUITE 207-B
COLUMBIA SC
29204-2415
US

V. Phone/Fax

Practice location:
  • Phone: 803-556-9439
  • Fax: 803-419-7497
Mailing address:
  • Phone: 803-556-9439
  • Fax: 803-419-7497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5631
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: