Basic Information
| Provider Information | |||||||||
| NPI: | 1649907106 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUTCH | ||||||||
| FirstName: | KRISTEN | ||||||||
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| Credential: | LAMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 58 SUMMERHILL DRIVE NE | ||||||||
| Address2: | |||||||||
| City: | LUDOWICI | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2546305128 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 205 S SKINNER AVE UNIT B | ||||||||
| Address2: | |||||||||
| City: | POOLER | ||||||||
| State: | GA | ||||||||
| PostalCode: | 313223221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123498043 | ||||||||
| FaxNumber: | 9129881204 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2022 | ||||||||
| LastUpdateDate: | 08/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.