Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003212903 |
---|---|
Provider Name | Keith Hutcheson |
First Address | Swainsboro, GA 30401-4440 |
Second Address | Swainsboro, GA 30401-4440 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2014 |
Last Update Date | 05/11/2014 |