Healthcare Provider Details

I. General information

NPI: 1689735219
Provider Name (Legal Business Name): CHRISTINA GLORIA HUTCHINSON LISW-CP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTINA HUTCHINSON BUTTS LISW-CP

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 03/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 NEIGHBOR LN
LEXINGTON SC
29072-7961
US

IV. Provider business mailing address

823 NEIGHBOR LN
LEXINGTON SC
29072-7961
US

V. Phone/Fax

Practice location:
  • Phone: 803-960-7394
  • Fax:
Mailing address:
  • Phone: 803-960-7394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7132
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number7132
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: