Provider Demographics
NPI:1316417728
Name:HUTSON, PAUL JR
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:HUTSON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3027 RACINE AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23509-1136
Mailing Address - Country:US
Mailing Address - Phone:757-918-3667
Mailing Address - Fax:
Practice Address - Street 1:5163 CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6501
Practice Address - Country:US
Practice Address - Phone:757-497-4703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician