Healthcare Provider Details

I. General information

NPI: 1275370199
Provider Name (Legal Business Name): KRISTINA ALEXIS HUTCHESON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2024
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 MORRIS ST
CHARLESTON WV
25301-1326
US

IV. Provider business mailing address

99 CRACKER BARREL DR STE 100
BARBOURSVILLE WV
25504-1650
US

V. Phone/Fax

Practice location:
  • Phone: 304-525-7851
  • Fax: 304-525-1073
Mailing address:
  • Phone: 304-525-7851
  • Fax: 304-697-1251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberDP00946571
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: