Provider Demographics
NPI:1699941450
Name:DAVIS-HUTTO, DOROTHY M
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:M
Last Name:DAVIS-HUTTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2549
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30031-2549
Mailing Address - Country:US
Mailing Address - Phone:678-953-1105
Mailing Address - Fax:
Practice Address - Street 1:558 MEDLOCK RD
Practice Address - Street 2:SUITE B
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1512
Practice Address - Country:US
Practice Address - Phone:678-953-1105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2492101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health