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General NPI Number Information
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NPI Number | 1073143863
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Entity Type | Individual
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Provider Name | SANDERICA HUTTO
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Gender | Female
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Dates
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Enumeration Date | 01/21/2020
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 1410 CUSTER AVE SE
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City | ATLANTA
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State | GA
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Zip | 30316-3304
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Country | US
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Telephone | 248-220-7980
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Fax |
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Provider Business Mailing Address
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Address Line | 8701 WADFORD DR STE 100
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City | RALEIGH
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State | NC
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Zip | 27616-9028
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-25-85998
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-25-85998
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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