Healthcare Provider Details

I. General information

NPI: 1437464872
Provider Name (Legal Business Name): CHARITY D HOTTON SSW, INTERN, AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2010
Last Update Date: 10/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13552 S 110 W STE 204
DRAPER UT
84020
US

IV. Provider business mailing address

6228 W HERITAGE HILL DR
HERRIMAN UT
84096-6973
US

V. Phone/Fax

Practice location:
  • Phone: 801-432-0883
  • Fax:
Mailing address:
  • Phone: 801-557-4482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number5338218-3503
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: