Healthcare Provider Details

I. General information

NPI: 1740748938
Provider Name (Legal Business Name): DONNA J HUTZLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2019
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 ALGONQUIN RD
HAMPTON VA
23661-1605
US

IV. Provider business mailing address

5342 MERGANSER CIR
GLOUCESTER VA
23061-3648
US

V. Phone/Fax

Practice location:
  • Phone: 757-722-9881
  • Fax:
Mailing address:
  • Phone: 804-694-7143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904006977
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: