Healthcare Provider Details

I. General information

NPI: 1184013393
Provider Name (Legal Business Name): DAVID HUTCHISON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2015
Last Update Date: 01/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8701 E MILL PLAIN BLVD APT. 81
VANCOUVER WA
98664-2569
US

IV. Provider business mailing address

8701 E MILL PLAIN BLVD APT. 81
VANCOUVER WA
98664-2569
US

V. Phone/Fax

Practice location:
  • Phone: 360-953-8919
  • Fax:
Mailing address:
  • Phone: 360-953-8919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP00003379
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00007995
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: